Date of Award


Document Type

Open Access Thesis

Degree Name

MS in Physician Assistant Studies (PA)


Physician Assistant Studies

First Advisor

Ryane Lester, PA-C


Background: Osteoporosis is a disease of the bones with decreased bone mineral density and bone mass, leading to poor bone quality/structure, increasing the risk of fragility fractures. Pharmacological treatment is recommended to decrease risk of fractures. Current first line treatment is with bisphosphonates; however, alternative treatment includes denosumab. Both bisphosphonates and denosumab are antiresorptive drugs but differ in mechanism of action. Bisphosphonates remain as first line treatment.

Purpose: The purpose of this literature review is aimed at the PICO question in adults with osteoporosis, what is the efficacy of denosumab compared to bisphosphonates in decreasing the risk of sustaining a fragility fracture? Treatment with bisphosphonates has remained as gold standard, however, an alternative effective treatment is denosumab. Therefore, the this review compares the efficacy of denosumab to bisphosphonates and whether this treatment option should be considered over bisphosphonates.

Methods: A comprehensive literature review was conducted using PubMed. Inclusion criteria included adult participants (men and women), however, many studies focused on postmenopausal women given the significant risk for predisposition to osteoporosis. Exclusion criteria were studies that did not include adults, studies published after 2017, and systematic reviews.

Conclusions: Based on the literature review, results suggest that the efficacy of denosumab treatment may be favored over treatment with bisphosphonates in increasing BMD. While treatment with denosumab increased BMD greater than bisphosphonates, further research/review should be conducted on the direct effect of fracture reduction with denosumab.


SC 11.PAS.2022.Cardoso.RT