Role of Denosumab and Zoledronic Acid in Geriatric Hip Fractures – A Comparative Analysis

Background: Osteoporotic hip fractures are on the raise in the world. Denosumab and zoledronic acid are among the commonly used current anti-osteoporotic medications to reduce hip fractures. The purpose of the present study was to compare the effectiveness and adverse events of denosumab and zoledronic acid in geriatric patients after a hip fracture. Materials and Methods: A prospective observational study was conducted between February 2020 and May 2021, and a total of 104 patients were included in the study. Fifty-three patients were given subcutaneous (SC) denosumab once in 6 months and 51 patients were given intravenous (IV) Zoledronic acid. The percentage changes in the bone mineral density (BMD) values from the baseline values were compared between both groups at 0, 12, and 24 months. Results: The percentage increase in Lumbar–BMD (L-BMD) was significantly higher in denosumab group when compared to the Zoledronic acid group at 12 months (6.8 ± 0.9 vs. 4.5 ± 0.7; P < 0.01) and 24 months (9.2 ± 0.9 vs. 7.1 ± 0.8; P < 0.001). There was a significant percentage change in the hip-bone mineral density in both the groups; however, a higher mean percentage change was noted in the denosumab group when compared to zoledronic acid group at 12 months and 24 months ( P < 0.04 and P < 0.001). Conclusion: We conclude that SC given denosumab has got a better efficacy comparedto the IV given zoledronic acid. Randomized control trials with a large sample size and longer follow-up are required to come to a conclusion regarding patient safety, compliance, and persistence.