Efficacy and Safety of Denosumab and Zoledronic Acid in the Treatment of Postmenopausal Osteoporosis—A Comparative Study of Bone Metabolism, Bone Density, and Sex Hormone Levels

To analyze and compare the effects of zoledronic acid (Aclasta) and denosumab (Prolia) treatment on sex hormones, bone mineral density (BMD), 25-hydroxyvitamin D (25(OH)D), procollagen type 1 N-terminal propeptide (P1NP), beta-CrossLaps (β-CTX), and adverse effects. Eighty postmenopausal women with osteoporosis were consecutively enrolled and then randomly assigned to two groups: 40 received zoledronic acid plus standard care (control group) and 40 received denosumab plus standard care (research group). Outcomes included sex hormone levels, BMD (lumbar spine, hip, and femoral neck), bone metabolism markers (25(OH)D, P1NP, and β-CTX), and adverse reactions, assessed over 1 year. No significant differences in luteinizing hormone, follicle-stimulating hormone, or estradiol levels were observed between the groups before and after treatment (p > 0.05). The baseline BMD and bone marker levels were similar between the groups (p > 0.05). After 6 months and 1 year, the denosumab group showed significantly higher BMD and 25(OH)D levels and lower P1NP and β-CTX levels than the zoledronic acid group (p < 0.05). Adverse reactions were less frequent with denosumab (2.5%) than with zoledronic acid (27.5%) (p < 0.05). Zoledronic acid and denosumab have comparable effects on sex hormone regulation. Denosumab has demonstrated superior improvements in BMD, bone metabolism, and safety profiles.