Denosumab Versus Zoledronic Acid for Muscle Strength and Physical Performance in Postmenopausal Osteoporosis: A 3-Year Prospective Study

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.