{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,2]],"date-time":"2026-11-02T20:33:38Z","timestamp":1793651618508,"version":"4.5.1"},"reference-count":234,"publisher":"Oxford University Press (OUP)","issue":"1","content-domain":{"domain":["eje.bioscientifica.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2018,7]]},"abstract":"<jats:p>The most widely used medications for the treatment of osteoporosis are currently bisphosphonates (BPs) and denosumab (Dmab). Both are antiresorptives, thus targeting the osteoclast and inhibiting bone resorption. Dmab achieves greater suppression of bone turnover and greater increases of bone mineral density (BMD) at all skeletal sites, both in na\u00efve and pretreated patients. No superiority on fracture risk reduction has been documented so far. In long-term administration, BPs reach a plateau in BMD response after 2\u20133 years, especially at the hip, while BMD increases progressively for as long as Dmab is administered. Both BPs and Dmab are generally considered safe, although they have been correlated to rare adverse events, such as osteonecrosis of the jaw and atypical femoral fractures. Dmab should be preferred in patients with impaired renal function. BPs are embedded in the bone, from which they are slowly released during bone remodeling, therefore continuing to act for years after their discontinuation. In contrast, Dmab discontinuation fully and rapidly reverses its effects on bone markers and BMD and increases the risk for fractures; therefore, Dmab discontinuation should be discouraged, especially in previously treatment-na\u00efve patients, regardless of the conventional fracture risk. In case of discontinuation, other treatment, mainly BPs, should immediately follow, although the optimal sequential treatment strategy is yet to be defined. Combination of teriparatide with Dmab or zoledronic acid, but not alendronate, provides increased BMD gains at all sites. In conclusion, both BPs and Dmab are safe and efficient therapeutic options although their particularities should be carefully considered in an individual basis.<\/jats:p>","DOI":"10.1530\/eje-18-0056","type":"journal-article","created":{"date-parts":[[2018,4,24]],"date-time":"2018-04-24T15:50:47Z","timestamp":1524585047000},"page":"R31-R45","update-policy":"https:\/\/doi.org\/10.1530\/crossmarkpolicy-1","source":"Crossref","is-referenced-by-count":118,"title":["THERAPY OF ENDOCRINE DISEASE: Denosumab vs bisphosphonates for the treatment of postmenopausal osteoporosis"],"prefix":"10.1093","volume":"179","author":[{"given":"Athanasios D","family":"Anastasilakis","sequence":"first","affiliation":[{"name":"1Department of Endocrinology, 424 General Military Hospital, Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stergios A","family":"Polyzos","sequence":"additional","affiliation":[{"name":"2First Department of Pharmacology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Polyzois","family":"Makras","sequence":"additional","affiliation":[{"name":"3Department of Endocrinology and Diabetes, 251 Hellenic Air Force & VA General Hospital, Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","reference":[{"key":"ref121","doi-asserted-by":"crossref","first-page":"2631","DOI":"10.1210\/jc.2005-2602","article-title":"Comparison of weekly treatment of postmenopausal osteoporosis with alendronate versus risedronate over two years","volume":"91","year":"2006","journal-title":"Journal of Clinical Endocrinology and Metabolism"},{"key":"ref351","doi-asserted-by":"crossref","first-page":"1075","DOI":"10.1056\/NEJMc062792","article-title":"Prolonged bisphosphonate release after treatment in children","volume":"356","year":"2007","journal-title":"New England Journal of Medicine"},{"key":"ref711","article-title":"Vertebral fractures following denosumab discontinuation in patients with prolonged exposure to bisphosphonates","year":"2018","journal-title":"Calcified Tissue International"},{"key":"ref2231","doi-asserted-by":"crossref","first-page":"1777","DOI":"10.1002\/jbmr.2216","article-title":"Overlapping and continued alendronate or raloxifene administration in patients on teriparatide: effects on areal and volumetric bone mineral density \u2013 the CONFORS Study","volume":"29","year":"2014","journal-title":"Journal of Bone and Mineral Research"},{"key":"ref2181","doi-asserted-by":"crossref","first-page":"1532","DOI":"10.1056\/NEJMoa1607948","article-title":"Romosozumab treatment in postmenopausal women with osteoporosis","volume":"375","year":"2016","journal-title":"New England Journal of Medicine"},{"key":"ref1141","doi-asserted-by":"crossref","first-page":"1733","DOI":"10.1007\/s00198-017-3940-4","article-title":"Cost-effectiveness of denosumab versus oral alendronate for elderly osteoporotic women in Japan","volume":"28","year":"2017","journal-title":"Osteoporosis International"},{"key":"ref1951","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1007\/s00774-015-0731-x","article-title":"The effects of switching daily teriparatide to oral bisphosphonates or denosumab in patients with primary osteoporosis","volume":"35","year":"2017","journal-title":"Journal of Bone and Mineral Metabolism"},{"key":"ref2151","doi-asserted-by":"crossref","first-page":"555","DOI":"10.1056\/NEJMoa050336","article-title":"One year of alendronate after one year of parathyroid hormone (1\u201384) for osteoporosis","volume":"353","year":"2005","journal-title":"New England Journal of Medicine"},{"key":"ref1751","doi-asserted-by":"crossref","first-page":"800","DOI":"10.1001\/jama.2011.176","article-title":"Effect of nitroglycerin ointment on bone density and strength in postmenopausal women: a randomized trial","volume":"305","year":"2011","journal-title":"JAMA"},{"key":"ref1471","doi-asserted-by":"crossref","first-page":"3785","DOI":"10.1210\/jc.2008-0353","article-title":"Early responsiveness of women with osteoporosis to teriparatide after therapy with alendronate or risedronate","volume":"93","year":"2008","journal-title":"Journal of Clinical Endocrinology and Metabolism"},{"key":"ref2201","doi-asserted-by":"crossref","first-page":"200","DOI":"10.1016\/j.mayocp.2016.10.009","article-title":"Eighteen months of treatment with subcutaneous abaloparatide followed by 6 months of treatment with alendronate in postmenopausal women with osteoporosis: results of the ACTIVExtend trial","volume":"92","year":"2017","journal-title":"Mayo Clinic Proceedings"},{"key":"ref851","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1016\/j.mehy.2011.03.039","article-title":"Denosumab and bisphosphonates: rivals or potential \u2018partners\u2019? 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