Early Denosumab Administration after Distal Radius Fractures in Postmenopausal Women: A Retrospective Comparison with Zoledronic Acid

Background To evaluate the effects of early administration of denosumab (DE) on bone healing and bone mineral density (BMD) in postmenopausal women with osteoporotic distal radius fractures treated with volar plate fixation. Although the safety of early bisphosphonate use has been well established, clinical evidence regarding the early use of DE remains limited. Methods A retrospective study was conducted on postmenopausal women aged 55 years or older who underwent volar plate fixation for osteoporotic distal radius fractures between April 2018 and July 2022. Participants were treated with either intravenous zoledronic acid (ZA group) or subcutaneous DE (DE group). BMD and bone turnover markers (C-terminal telopeptide of type 1 collagen [CTX-1] and osteocalcin) were measured preoperatively, at 3 months, and 1 year after surgery. Radiographic outcomes, range of motion (ROM), and Disabilities of the Arm, Shoulder, and Hand (DASH) scores were evaluated at 1 year. Additionally, patient satisfaction was assessed through a telephone survey. Results A total of 65 patients were included (35 in the ZA group, 30 in the DE group). Both groups showed significant improvements in lumbar spine and femoral neck BMD T-scores at 1 year, with no significant difference between the groups. Bone resorption marker CTX-1 decreased significantly in both groups, with a significant intergroup difference at 1 year (p = 0.048). Bone union time was similar (6.9 weeks) in both groups. Clinical outcomes, including ROM and DASH scores, were comparable between the 2 groups. The frequency of adverse drug reactions was higher in the ZA group (14.3%) compared to the DE group (3.3%). The DE group reported significantly higher satisfaction levels compared to the ZA group. Conclusions Early administration of DE after distal radius fracture surgery is safe and does not impair bone healing. Given the higher patient satisfaction and lower rate of adverse events, DE may be a favorable option for early osteoporosis management in the postoperative setting.