Journal of cachexia, sarcopenia and muscle
Denosumab Versus Zoledronic Acid for Muscle Strength and Physical Performance in Postmenopausal Osteoporosis: A 3-Year Prospective Study
By Li X, Yuan Z, Ma N and 3 others.
Abstract
Background
Osteoporosis and sarcopenia frequently coexist in older adults, yet whether denosumab provides muscle-related benefits beyond bone remains uncertain. We compared denosumab and zoledronic acid across functional, imaging, biologic and study-defined sarcopenia outcomes based on an Asian Working Group for Sarcopenia (AWGS) 2025-informed framework and examined whether early osteoprotegerin (OPG)/soluble receptor activator of nuclear factor-kappa B ligand (sRANKL) responses tracked with later benefit.
Methods
This prospective observational cohort study included 186 postmenopausal women with osteoporosis and prescreened sarcopenia risk (82 denosumab, 104 zoledronic acid). Assessments at baseline and 12, 24 and 36 months included grip strength, gait speed, 5-times chair stand, lumbar spine and femoral neck bone mineral density (BMD), dual-energy X-ray absorptiometry (DXA)-derived appendicular skeletal muscle mass index (ASMI), computed tomography (CT)-derived T12-L4 skeletal muscle volume index (SMVI), skeletal muscle density (SMD), intermuscular fat volume index (IMFI), visceral fat volume index (VFI) and OPG/sRANKL-centred biologic markers. Continuous outcomes were analysed using linear mixed-effects models, categorical outcomes with Fisher exact tests and responder and mediation analyses.