Efficacy of annual zoledronic acid in initial percutaneous kyphoplasty patients with osteoporotic vertebral compression fractures: a 3-year follow-up study

Development and validation of a prediction model for vertebral recompression and adjacent vertebral fracture after kyphoplasty in geriatric patients

PURPOSE

Short-term efficacy of percutaneous kyphoplasty (PKP) for treating osteoporotic vertebral compression fracture (OVCF) in elderly patients is good, but long-term complications such as vertebral recompression (VRC) and adjacent vertebral fracture (AVF) may arise. Identifying risk factors in patients with poor prognoses, we developed a nomogram model to mitigate these potential complications.

METHODS

Patients with OVCFs who underwent PKP had their medical data retrospectively evaluated. Analysis of the sample included their pre- and postoperative conditions. Stepwise logistic regression analyses were conducted to identify independent risk factors for postoperative complications. For forecasting the likelihood of postoperative comorbidities, we offered a nomogram. The prognostic performance was assessed using the receiver operating characteristic curve (ROC), calibration curve, and decision curve analyses (DCA). Internal model validation using the Bootstrap method.

RESULTS

A total of 235 patients were included in this study. Among them, 147 patients were utilized to develop nomograms and for internal validation, while the remaining 88 patients from a different time period were designated as the external validation cohort. The results of stepwise logistic regression analysis showed that thoracolumbar (TL) fracture, posterior wall of vertebral fracture, vertebral compression > 30%, and lack of continuous anti-osteoporosis therapy after surgery as independent risks associated with poor prognosis. The nomogram exhibited outstanding predictive accuracy and clinical utility.

CONCLUSIONS

This study identified four independent predictors of poor prognosis following PKP and devised a straightforward yet efficient predictive model. This model offers valuable insights for guiding clinical decision-making in the management of elderly patients with OVCFs.

Can Bisphosphonate Therapy Reduce Overall Mortality in Patients With Osteoporosis? A Meta-analysis of Randomized Controlled Trials

BACKGROUND

For patients with osteoporosis, bisphosphonate therapy can reduce the risk of fractures, but its effect on reducing mortality remains unclear. Previous studies on this topic have produced conflicting results and generally have been too small to definitively answer the question of whether bisphosphonate therapy reduces mortality. Therefore, a meta-analysis may help us arrive at a more conclusive answer.

QUESTIONS/PURPOSES

In a large meta-analysis of placebo-controlled randomized controlled trials (RCTs), we asked: (1) Does bisphosphonate use reduce mortality? (2) Is there a subgroup effect based on whether different bisphosphonate drugs were used (zoledronate, alendronate, risedronate, and ibandronate), different geographic regions where the study took place (Europe, the Americas, and Asia), whether the study was limited to postmenopausal female patients, or whether the trials lasted 3 years or longer?

METHODS

We conducted a systematic review using multiple databases, including Embase, Web of Science, Medline (via PubMed), Cochrane Library, and ClinicalTrials.gov, with each database searched up to November 20, 2023 (which also was the date of our last search), following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We included randomized, placebo-controlled clinical trials with participants diagnosed with osteoporosis and receiving bisphosphonate treatment. We excluded papers posted to preprint servers, other unpublished work, conference abstracts, and papers that were registered on ClinicalTrials.gov but were not yet published. We collected 2263 records. After excluding records due to study type, study content not meeting the inclusion criteria, and duplicates, our meta-analysis included 47 placebo-controlled RCTs involving 59,437 participants. Data extraction, quality assessment, and statistical analyses were performed. The evaluation of randomized trials for potential bias was conducted using the revised Cochrane Risk of Bias tool. This assessment encompassed factors such as sequence generation, allocation concealment, subject blinding, outcome assessor blinding, incomplete outcome data, and reporting bias. Some studies did not provide explicit details regarding random sequence generation, leading to a high risk of selection bias. A few studies, due to their open-label nature, were unable to achieve double-blind conditions for both the subjects and the researchers, resulting in intermediate performance bias. Nevertheless, the overall study quality was high. Due to the low heterogeneity among the studies, as evidenced by the low statistical heterogeneity (that is, a low I2 statistic), we opted for a fixed-effects model, indicating that the effect size is consistent across the studies. In such cases, the fixed-effects model can provide more precise estimates. According to the results of the funnel plot, we did not find evidence of publication bias.

RESULTS

The use of bisphosphonates did not reduce the overall risk of mortality in patients with osteoporosis (risk ratio 0.95 [95% CI 0.88 to 1.03]). Subgroup analyses involving different bisphosphonate drugs (zoledronate, alendronate, risedronate, and ibandronate), regions (Europe, the Americas, and Asia), diverse populations (postmenopausal female patients and other patients), and trials lasting 3 years or longer revealed no associations with reduced overall mortality.

CONCLUSION

Based on our comprehensive meta-analysis, there is high-quality evidence suggesting that bisphosphonate therapy for patients with osteoporosis does not reduce the overall risk of mortality despite its effectiveness in reducing the risk of fractures. The primary consideration for prescribing bisphosphonates to individuals with osteoporosis should continue to be centered on reducing fracture risk, aligning with clinical guidelines. Long-term studies are needed to investigate potential effects on mortality during extended treatment periods.

LEVEL OF EVIDENCE

Level I, therapeutic study.

Efficacy and safety of zoledronic acid in the treatment of osteoporosis: A meta-analysis of randomized controlled trials

Purpose

Zoledronic acid can inhibit the activity of osteoclasts, and thus, may slow or inhibit bone loss. The purpose of this study was to systematically evaluate the efficacy and safety of zoledronic acid in the treatment of osteoporosis.

Methods

Four databases, PubMed, Embase, Cochrane Library, and Web of Science, were systematically searched up to December 26, 2022. The primary outcomes included bone mineral density (BMD), carboxy-terminal cross-linked telopeptide of type 1 collagen (CTX), bone-specific alkaline phosphatase (BSAP), procollagen type 1 N-terminal prope-ptide (P1NP), adverse events, and fracture. Secondary outcomes included serum sclerostin level, Visual Analogue Scale (VAS) score, and Oswestry Disability Index (ODI).

Results

A total of 22 randomized controlled trials were included in this meta-analysis. Meta-analysis results showed that zoledronic acid was effective in increasing BMD of the lumbar spine, femoral neck, trochanter and serum sclerostin level; and reduced CTX, BSAP, P1NP, VAS score, and ODI in patients with osteoporosis. Regarding safety, zoledronic acid could reduce the incidence of fractures but had relatively more adverse events.

Conclusion

Zoledronic acid can significantly improve BMD of the lumbar spine, femoral neck and trochanter, and effectively reduce incidence of fracture in patients with osteoporosis, thereby significantly improving patients' quality of life. However, the incidence of adverse events was higher than that of patients treated with placebo.

Can zoledronic acid reduce the risk of cage subsidence after oblique lumbar interbody fusion combined with bilateral pedicle screw fixation in the elderly population? A retrospective study

BACKGROUND

The objective of this study was to evaluate the potential of zoledronic acid for reducing the incidence of cage subsidence and enhancing interbody fusion rates following oblique lumbar interbody fusion (OLIF) surgery, particularly as the first reported evidence of the role of zoledronic acid combined with OLIF.

METHODS

A retrospective analysis was conducted on data from 108 elderly patients treated for degenerative lumbar diseases using OLIF combined with bilateral pedicle screw fixation from January 2018 to December 2021. Patients were divided into the zoledronic acid (ZOL) group (43 patients, 67 surgical segments) and the control group (65 patients, 86 surgical segments). A comparative analysis of the radiographic and clinical outcomes between the groups was performed, employing univariate and multivariate regression analyses to explore the relationships between cage subsidence and the independent variables.

RESULTS

Radiographic outcomes, including anterior height, posterior height, disc height, coronal disc angle, foraminal height, and lumbar lordosis, were not significantly different between the two groups. Similarly, no statistically significant differences were noted in the back visual analog scale (VAS) scores and Oswestry Disability Index (ODI) scores between the groups. However, at the 1-year follow-up, the leg VAS score was lower in the ZOL group than in the control group (P = 0.028). The ZOL group demonstrated a notably lower cage subsidence rate (20.9%) than did the control group (43.0%) (P < 0.001). There was no significant difference in the interbody fusion rate between the ZOL group (93.0%) and the control group (90.8%). Non-use of zoledronic acid emerged as an independent risk factor for cage subsidence (OR = 6.047, P = 0.003), along with lower bone mineral density, lower postoperative anterior height, and concave endplate morphology. The model exhibited robust discriminative performance, with an area under the curve (AUC) of 0.872.

CONCLUSION

The administration of zoledronic acid mitigates the risk of cage subsidence following OLIF combined with bilateral pedicle screw fixation in elderly patients; however, it does not improve the interbody fusion rate.

New Insights in the Pathophysiology, Epidemiology, and Response to Treatment of Osteoporotic Vertebral Fractures

CONTEXT

Vertebral fractures (VFs) make up an important but challenging group of fractures often caused by osteoporosis. Osteoporotic fractures pose unique diagnostic challenges in generally requiring imaging for diagnosis. The objective of this narrative mini-review is to provide an overview of these recent advances in our knowledge of VF pathophysiology and epidemiology with particular focus on endocrine diseases, prevention, and treatment.

EVIDENCE ACQUISITION

We searched PubMed on May 23, 2022, for studies of VFs in humans. Results were limited to papers available as full-text publications in English, published from 2020 and onward. This yielded 3457 citations. This was supplemented by earlier publications selected to add context to the recent findings.

EVIDENCE SYNTHESIS

Studies addressed VF risk in hyperthyreosis, hyperparathyroidism, acromegaly, Cushing syndrome, primary aldosteronism, and diabetes. For pharmaceutical treatment, new studies or analyses were identified for romosozumab and for weekly teriparatide. Several studies, including studies in the immediate pipeline, were intervention studies with vertebroplasty or kyphoplasty, including combination with stem cells or pharmaceuticals.

CONCLUSIONS

Endocrinologists should be aware of the high likelihood of osteoporotic VFs in patients with endocrine diseases. Though licensed treatments are able to substantially reduce the occurrence of VFs in patients with osteoporosis, the vast majority of recent or ongoing randomized controlled trials in the VF area focus on advanced invasive therapy of the fracture itself.

Comparison of thoracolumbar versus non-thoracolumbar osteoporotic vertebral compression fractures in risk factors, vertebral compression degree and pre-hospital back pain

BACKGROUND

Thoracolumbar spine is at high risk of osteoporotic vertebral compression fractures (OVCF). This study aimed to identify the differences in risk factors, vertebral compression degree and back pain characteristics of thoracolumbar OVCF (TL-OVCF) and non-thoracolumbar OVCF (nTL-OVCF).

METHODS

OVCF patients hospitalized in a spine center between June 2016 and October 2020 were retrospectively studied. Demographics, comorbidity, spine trauma, bone mineral density, duration of pre-hospital back pain, extent of vertebral marrow edema, and degree of vertebral compression of patients with nTL-OVCF were summarized and compared to those with TL-OVCF.

RESULTS

A total of 944 patients with acute single-segment OVCF were included. There were 708 (75.0%) TL-OVCF located in T11-L2 and 236 (25.0%) nTL-OVCF in lower lumbar (L3-L5) and middle thoracic (T5-T10) spine. The female-male ratio was 4.1 in nTL-OVCF and differed not significantly from TL-OVCF. The middle thoracic OVCF were older and had higher comorbidity of coronary heart disease (21.3%) and cerebral infarction (36.3%) than TL-OVCF (12.1% and 20.6%). In nTL-OVCF the ratio of apparent spine trauma (44.9%) and pre-hospital back pain ≤ 1 week (47.5%) was lower than in TL-OVCF (66.9% and 62.6%). The T-score value of lumbar spine was - 2.99 ± 1.11, - 3.24 ± 1.14, - 3.05 ± 1.40 in < 70, 70-80, > 80 years old TL-OVCF and differed not significantly from nTL-OVCF. The lower lumbar OVCF had more cranial type of vertebral marrow edema (21.8%) and fewer concurrent lumbodorsal fasciitis (30.8%) than TL-OVCF (16.8% and 43.4%). In TL-OVCF the anterior-posterior vertebral height ratio was lower with back pain for > 4 weeks than for ≤ 1, 1-2, and 2-4 weeks. In nTL-OVCF the degree of vertebral compression differed not significantly with pre-hospital back pain for ≤ 1, 1-2, 2-4, and > 4 weeks.

CONCLUSIONS

Thoracolumbar spine has 2-folds higher risk of OVCF than non-thoracolumbar spine. Non-thoracolumbar OVCF are not associated with female gender, apparent spine trauma or poor bone mineral density, but tend to maintain the degree of vertebral compression and cause longer duration of pre-hospital back pain.

Predictors of residual low back pain in patients with osteoporotic vertebral fractures following percutaneous kyphoplasty

Objective

Patients with osteoporotic vertebral fractures (OVFs) often suffer from residual low back pain (LBP) after percutaneous kyphoplasty (PKP). The purpose of this study was to identify risk factors for postoperative residual LBP and to develop a nomogram to predict the occurrence of residual LBP.

Methods

We retrospectively reviewed 236 patients who underwent PKP for OVFs and had a minimum follow-up of 12 months. The mean age was 72.1 ± 6.3, 74.3% were female and 25.7% were male. Patients with LBP VAS scores ≥ 3.5 at the 12th month postoperatively were considered to have residual LBP. Risk factors for residual LBP were identified by univariate and multifactorial logistic regression analysis. Then, a predictive nomogram was constructed and validated using the bootstrap method. The discrimination, calibration, and clinical utility of the nomogram were assessed using a receiver operating characteristic curve (ROC), a calibration curve, and a decision curve analysis (DCA).

Results

univariate and multifactorial logistic regression analysis identified depression (P = 0.02), intravertebral vacuum cleft (P = 0.01), no anti-osteoporosis treatment (P < 0.001), cement volume <3 ml (P = 0.02), and cement distrubution (P = 0.01) as independent risk factors for residual LBP. The area under the ROC was 0.83 (0.74-0.93) and further validated by bootstrap method was 0.83 (0.73-0.92). The calibration curve illustrated the consistency between the predicted probability and the observed results. DCA showed that nomogram exhibits clinical utility and net benefit when the threshold probability is between 6% and 73%.

Conclusions

Our study found that depression, intravertebral vacuum cleft, no anti-osteoporosis treatment, cement volume <3 ml and cement distribution represent independent risk factors for residual LBP. The nomogram containing the above five predictors can accurately predict the risk of residual LBP after surgery.

Effectiveness and Safety of Treatments to Prevent Fractures in People With Low Bone Mass or Primary Osteoporosis: A Living Systematic Review and Network Meta-analysis for the American College of Physicians

BACKGROUND

The prevalence of osteoporosis is increasing in the United States.

PURPOSE

To evaluate low bone mass and osteoporosis treatments to prevent fractures.

DATA SOURCES

Ovid MEDLINE ALL, Ovid Evidence Based Medicine Reviews: Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and ClinicalTrials.gov from 2014 through February 2022.

STUDY SELECTION

Adults receiving eligible interventions for low bone mass or osteoporosis. Randomized controlled trials (RCTs) for fracture outcomes, and RCTs and large observational studies (n ≥1000) for harms.

DATA EXTRACTION

Abstracted by 1 reviewer and verified by a second. Independent, dual assessments of risk of bias and certainty of evidence (CoE).

DATA SYNTHESIS

We included 34 RCTs (in 100 publications) and 36 observational studies. Bisphosphonates and denosumab reduced hip, clinical and radiographic vertebral, and other clinical fractures in postmenopausal females with osteoporosis (moderate to high CoE). Bisphosphonates for 36 months or more may increase the risk for atypical femoral fractures (AFFs) and osteonecrosis of the jaw (ONJ), but the absolute risks were low. Abaloparatide and teriparatide reduced clinical and radiographic vertebral fractures but increased the risk for withdrawals due to adverse events (WAEs; moderate to high CoE). Raloxifene and bazedoxifene for 36 months or more reduced radiographic vertebral but not clinical fractures (low to moderate CoE). Abaloparatide, teriparatide, and sequential romosozumab, then alendronate, may be more effective than bisphosphonates in reducing clinical fractures for 17 to 24 months in older postmenopausal females at very high fracture risk (low to moderate CoE). Bisphosphonates may reduce clinical fractures in older females with low bone mass (low CoE) and radiographic vertebral fractures in males with osteoporosis (low to moderate CoE).

LIMITATION

Few studies examined participants with low bone mass, males, or Black-identifying persons, sequential therapy, or treatment beyond 3 years.

CONCLUSION

Bisphosphonates, denosumab, abaloparatide, teriparatide, and romosozumab, followed by alendronate, reduce clinical fractures in postmenopausal females with osteoporosis. Abaloparatide and teriparatide increased WAEs; longer duration bisphosphonate use may increase AFF and ONJ risk though these events were rare.

PRIMARY FUNDING SOURCE

American College of Physicians. (PROSPERO: CRD42021236220).

Establishment and Verification of a Predictive Nomogram for New Vertebral Compression Fracture Occurring after Bone Cement Injection in Middle-Aged and Elderly Patients with Vertebral Compression Fracture

OBJECTIVE

New vertebral compression fracture (NVCF) occurring after bone cement injection in middle-aged and elderly patients with vertebral compression fracture is very common. Preoperative baseline characteristics and surgical treatment parameters have been widely studied as a risk factor, but the importance of the patients' laboratory indicators has not been thoroughly explored. We aimed to explore the relationship between laboratory indicators and NVCF, and attempt to construct a clinical prediction model of NVCF together with other risk factors.

METHODS

Retrospective analysis was performed for 200 patients who underwent bone cement injection (percutaneous kyphoplasty or vertebroplasty) for vertebral compression fractures between January 2019 and January 2020. We consulted the relevant literature and collated the factors affecting the occurrence of NVCF. Feature selection of patients with NVCF was optimized using the least absolute shrinkage and selection operator regression model, which was used to conduct multivariable logistic regression analysis, to create a predictive model incorporating the selected features. The discrimination, calibration, and clinical feasibility of the predictive model were assessed using the concordance index (C-index), calibration plots, and decision curve analysis. Internal validation was performed using Bootstrap resampling verification.

RESULTS

Time from injury to surgery exceeding 7 days, low osteocalcin levels, elevated homocysteine levels, osteoporosis, mode of operation (percutaneous vertebroplasty), lack of postoperative anti-osteoporosis treatment, and poor diffusion of bone cement were independent risk factors for NVCF in middle-aged and elderly patients with vertebral compression fracture after bone cement injection. The C-index of the nomogram constructed using these seven factors was 0.895, indicating good discriminatory ability. The calibration plot showed that the model was well calibrated. Bootstrap resampling verification yielded a significant C-index of 0.866. Decision curve analysis demonstrated that the greatest clinical net benefit for predicting NVCF after bone cement injection could be achieved with a threshold of 1%-91%.

CONCLUSION

This nomogram can effectively predict NVCF incidence after bone cement injection in middle-aged and elderly patients with vertebral compression fracture, thus aiding clinical decision-making and postoperative management, promoting effective postoperative rehabilitation, and improving the quality of life.

Analysis of the Effect of Percutaneous Cone Shaping in Patients with Osteoporotic Vertebral Fractures

Objective. To study and analyze the clinical effect of percutaneous cone shaping in patients with osteoporotic vertebral fractures. Methods. A total of 100 patients with vertebral osteoporotic fracture treated in our hospital from June 2019 to September 2020 were selected, and there were 50 patients with vertebral osteoporotic fracture in each group. Patients could be divided into two groups according to different treatment plans: one group was vertebroplasty patients for group A, and the other group was nonsurgical treatment patients for group B. The incidence of complications during treatment and follow-up was recorded in both groups. Results. According to a study, both groups of patients completed the treatment and follow-up, no patients lost to follow-up or death, the VAS scores and ADL scores of patients before treatment were higher, and there was no significant difference at baseline ( $P>0.05$ ). After different treatment methods, the VAS score and ADL score of group A showed good improvement after treatment compared with that before treatment, and there were certain differences within the group, with statistical significance ( $P<0.05$ ). Intragroup comparison. The VAS scores of group B at 1 week, 1 month, 3 months, and 12 months after treatment were all superior to those before treatment, and the ADL scores at 1 month, 3 months, and 12 months after treatment were all superior to those before treatment, with statistically significant differences ( $P<0.05$ ). VAS scores and ADL scores showed good improvement 1 day, 1 week, and 1 month after treatment compared with those before treatment. However, there were no significant differences in the VAS score and ADL score between the two groups at 3 and 12 months after treatment. The incidence of complications in group A is lower than that in group B. The incidence of complications in group A is as follows: there was 1 case of recurrent vertebral fracture and 1 case of urinary tract infection, and the overall incidence of complications was 4.00%. In group B, there were 1 case of recurrent fracture, 3 cases of bedsore, 2 cases of urinary tract infection, and 2 cases of pulmonary infection, and the incidence of total complications was 16.00%. After comparison between groups, there was a significant difference in the incidence of complications between the two groups, and the difference was statistically significant ( $P<0.05$ ). Conclusions. Percutaneous cone plasty can provide rapid relief of pain symptoms in patients with osteoporotic vertebral fractures and significantly improve their daily activities. However, there was no significant difference in long-term recovery from group B. In terms of the incidence of complications, the incidence of complications in group A was lower than that in group B after certain treatment.

Development and Validation of a Self-Quantification Scale for Patients With Hypertension

Background

The self-management ability of patients with hypertension is poor, and self-quantification increases gradually with the development of electronics. Self-quantification for patients with hypertension has important implications for individual health. However, there is a lack of relevant scales at present, and we aim to develop a self-quantified scale for patients with hypertension.

Methods

The instrument was developed based on protection motivation theory with literature review, a qualitative interview study and focus group discussions, and pilot testing. A total of 360 patients with hypertension were investigated using the scale. The psychometric properties of the scale were evaluated concerning validity and reliability employing internal consistency reliability, split-half reliability, test-retest reliability, content validity (S-CVI/Ave and I-CVI), and construct validity (exploratory factor analysis and confirmatory factor analysis).

Results

The final scale had 30 items with seven sub-domains. The Cronbach's α for all domains was 0.900 with a range of 0.817–0.938. The split-half reliability coefficient for all domains was 0.743 with a range of 0.700–0.888. The test-retest reliability coefficient for all domains was 0.880 with a range of 0.849–0.943. The S-CVI/Ave for all domains was 0.922 with a range of 0.906- 0.950, and the I-CVI of each item was a range of 0.800–1.000. The result of confirmatory factor analysis of this scale showed that χ2/df was 2.499, RMSEA = 0.065, GFI=0.865, NFI=0.894, IFI=0.934, TLI=0.914, CFI=0.933, RFI=0.865. The Pearson's coefficients between the total scale and every domain were ranging from 0.347 to 0.695, and each domain ranged from 0.130 to 0.481.

Conclusion

The scale has good validity and reliability and can be used as a self-quantification scale for patients with hypertension.

Efficacy of Yigu® versus Aclasta® in Chinese postmenopausal women with osteoporosis: a multicenter prospective study

Zoledronic acid (ZOL) is a therapy inhibiting bone resorption. In this study, generic ZOL (Yigu®) showed its clinical efficacy consistency with original ZOL (Aclasta®) in Chinese postmenopausal women with osteoporosis. This study provides a practical basis for the application of Yigu® in Chinese population.

INTRODUCTION

Yigu® has been approved its bioequivalence to Aclasta®. However, the clinical efficacy and safety of Yigu® have not been evaluated yet. Here, we compared the effectiveness and safety between Yigu® and Aclasta® in Chinese postmenopausal women with osteoporosis and assessed the efficacy of intravenous infusion of ZOL.

METHODS

This was a randomized open-label, active-controlled study in postmenopausal women with osteoporosis of 14 clinical centers in China. Postmenopausal women with osteoporosis were recruited and randomized to receive a single infusion of 5 mg Yigu® or Aclasta®. The primary endpoint was the percentage change in bone mineral density (BMD) at lumbar spine after 12 months of treatment and was assessed for equivalence. The secondary endpoint was the percentage change in BMD at proximal femur after 12 months. Additional secondary endpoints were percentage changes in BMD at the above sites after 6 months of treatment and changes in bone turnover biomarkers during ZOL treatment. Safety was also evaluated and compared between two groups.

RESULTS

A total of 458 postmenopausal women with osteoporosis were enrolled (n = 227, Yigu®; n = 231, Aclasta®). The mean percentage change in the BMD had no statistical difference at the lumbar spine (5.32% vs 5.18%), total hip (2.72% vs 2.83%), and femoral neck (2.37% vs 2.81%) between Yigu® and Aclasta® groups after 12 months of treatment. The mean difference of BMD change at the lumbar spine after 12 months between two groups was 0.15% (95% CI: - 0.71 to 1.00, equivalence margin: - 1.5%, 1.5%), demonstrating the treatments were equivalent. Meanwhile, the decreases in the P1NP and β-CTX showed no difference between two groups after 14 days and 6 and 12 months of treatment. As regards the whole sample, BMD significantly increased after 12 months of treatment. Also, serum C-terminal telopeptide of type 1 collagen (β-CTX) and procollagen 1 N-terminal peptide (P1NP) significantly decreased at each visit period. The overall adverse events were comparable and quite well between two groups.

CONCLUSION

Intravenous infusion of zoledronic acid achieved the potent anti-resorptive effects which led to significant increase in BMD of Chinese postmenopausal women with osteoporosis. Yigu® was equivalent to Aclasta® with respect to efficacy and safety.