Abstract

RENAL SAFETY AND EFFICACY OF DENOSUMAB COMPARED WITH ZOLEDRONIC ACID IN CANCER-RELATED BONE DISEASE AND OSTEOPOROSIS: A NARRATIVE REVIEW

Prateeksha Vinnu*, Adnan Sharief SK, Adithya Shetty H.

Abstract

Denosumab (DMAb), a monoclonal antibody against RANK ligand, and zoledronic acid (ZA), an intravenous bisphosphonate, are widely used to prevent skeletal-related events (SREs) in patients with bone metastases and osteoporosis. This narrative review compares the efficacy and safety of DMAb and ZA, with a particular focus on renal outcomes across malignancy- and osteoporosis-related indications. In patients switched from ZA to DMAb, bone mineral density (BMD) gains were greater; however, discontinuation of DMAb was reported rapid BMD loss and an increased risk of multiple vertebral fractures in some studies. Acute phase reactions were higher with ZA therapy. Several studies reported higher rates of hypocalcaemia with DMAb than ZA, while data on hypercalcaemia are heterogeneous, with some suggesting increased rates under DMAb and others favouring ZA. Hypercalcaemia can be treated with ZA. Hypocalcaemia occurred frequently in patients who are not onsupplements. Renal function deterioration was more frequently reported with ZA than with DMAb. In contrast, in longterm DMAb extension studies, fewer than 3% of participants with baseline CKD stages 2–3 progressed to stage 4 CKD. High adherence to DMAb had high eGFR levels. Renal failure, Acute kidney injury and other adverse renal events are frequent with ZA. A higher percentage of patients experienced grade3 or 4 elevations in serum creatinine with ZA than with DMAb. When comparing denosumab and zoledronic acid, the available data indicate that denosumab provides greater benefits, particularly in terms of renal safety. As a potent anti- resorptive agent, denosumab shows fewer renal adverse events and is generally safer for patients with compromised kidney function compared to zoledronic acid.

Keywords: Zoledronic Acid, Denosumab, Sres, Adverse Renal Events, Sr.Cr, Hypercalcaemia, Hypocalcaemia, Onj, Bmd Gain, Ckd, Cancers, Osteoporosis.