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Osteoporosis results largely from bone resorption by osteoclasts, which depend on a cytokine known as receptor activator of nuclear factor-κB ligand (RANKL) to develop, function, and survive. Denosumab, a human monoclonal antibody against RANKL, inhibits osteoclast-mediated bone resorption. In a manufacturer-sponsored trial, 7868 women (mean age, 72; mean spine and total hip BMD T-scores at enrollment, –2.8 and –1.9, respectively) were randomized to receive 60-mg denosumab or placebo subcutaneously every 6 months for 3 years.
Relative risk for new radiographically diagnosed vertebral fractures was 68% lower in the denosumab group than in the placebo group (36-month incidence, 2.3% vs. 7.2%; P<0.001). Risk for hip fractures was 40% lower (0.7…