Studies have also suggested that ZA may exhibit antitumor effects, including inhibition of tumor cell migration, invasion, proliferation, and viability, further reducing skeletal tumor burden and bone metastasis.19, 20, 21, 22 In comparison, denosumab is a monoclonal antibody that binds with high affinity to RANKL, a key mediator in osteoclastic formation and activity, thereby disrupting bone resorption.23,24 The disruption of the RANKL signaling pathway by denosumab may explain the enhanced prevention of pathological fractures with denosumab in comparison to ZA. Here, TNFSF11 is linked to neoplasm.