A Study to Evaluate the Efficacy and Safety of HLX14 vs. Denosumab Prolia® in Postmenopausal Women With Osteoporosis at High Risk of Fracture

Prior treatment

• Active or uncontrolled infection requiring systemic therapy within 2 weeks prior to first dose;
• Participating in clinical trials of other medical devices or drugs or reaching less than 30 days or 5 half-lives after the last visit in the clinical trials of other medical devices or drugs (non-bone metabolism related drugs) (whichever is longer, calculated from the date of ICF signing). Bone metabolism related drugs should comply with the corresponding prohibition time limit, and anti-osteoporosis drugs should be excluded. Those who have failed in the screening period of other clinical trials but have not yet been treated with drugs/clinical devices can be included in this study;
• Having received Denosumab and its biosimilars, or Romosozumab and its biosimilars, cathepsin K inhibitor therapy prior to randomization;
• Having received the following osteoporosis treatments, or medications that affect bone metabolism or any herbal medications:
  • 1\) Use of bisphosphonates(oral or intravenous) ,fluoride and strontium prior to randomization.
  • 2\) Use of parathyroid hormone (PTH) or PTH analogues, such as teriparatide, within 12 months prior to randomization.
  • 3\) Use of systemic hormone replacement therapy (HRT), selective estrogen receptor modulators, tibolone, anabolic hormones, testosterone, androgens, gonadotropin releasing hormone agonists, adrenocorticotropic hormone, within 12 months prior to randomization.
  • 4\) Use of calcitonin, calcitriol, alfacalcidol and vitamin D analogues within 12 months prior to randomization: 5) Use of any of the following within 3 months prior to randomization: heparin, warfarin, anticonvulsants (except benzodiazepines), systemic use of ketoconazole, cinacalcet, aluminum, lithium, protease inhibitors, methotrexate, and oral or parenteral glucocorticoids (≥ 5 mg/day prednisone daily or equivalent for \> 10 days).
  • 6\) Use of any herbal medications within 2 weeks (If the herbal medications contain the above components that affect bone metabolism, should follow the corresponding elution period of bone metabolism components);
  • 18\. Subjects with a history or presence of hip fracture or .prevalent vertebral (any severe or more than 2 moderate prevalent vertebral fractures);
  • 19\. Subjects in active healing fracture in the opinion of the investigator;
  • 20\. Subjects at very high risk of fracture who must be treated immediately with an active drug in the opinion of the investigator;
  • 21\. Known allergic to the drugs listed in the study protocol, including a history of allergy to denosumab, any recombinant protein drugs, or any ingredients used in HLX14 or Prolia®;
  • 22\. With a history and presence of smoking, except for the following suituation:
• non-smokers (A history of never smoking \> 5 cigarettes/day and not smoking at all for at least the last 2 years prior to screening process)

Other illness

• Diseases that may affect bone metabolism;
• Thyroid disorders;
• With serious primary diseases in the cardiovascular, cerebrovascular, or hematopoietic system;
• Malabsorption syndrome or various gastrointestinal disorders associated with malabsorption;
• Severe renal impairment due to renal disease with a glomerular filtration rate \< 30 mL/min;
• Hepatic diseases;
• With serious primary diseases in the cardiovascular, cerebrovascular, or hematopoietic system judged by investigator;
• Positive for human immunodeficiency virus (HIV) antibody;
• Oral and dental diseases;

Lab values

• Abnormal serum calcium;
• Type 1 diabetic patients, or type 2 diabetic patients who have poor blood glucose control or are treated with insulin, glucagon-like peptide-1 (GLP-1), thiazolidinediones, SGLT2 inhibitors, etc;
• light smokers (with smoking habit \<5 cigarettes/day, smoking period \<10 years. Light smokers should have not smoked more than 1 cigarette in the week before starting the medical screening process)
  • 23\. With a history of drug or alcohol abuse, and with evidence of alcohol or drug abuse within 12 months;
  • 24\. Various physical or psychiatric disorders or laboratory abnormalities which, in the opinion of the investigator, will prevent the subject from completing the study or interfere with the interpretation of study results. Or the subjects presenting other factors not suitable for participation in the opinion of the investigator.

Other

• Subjects with rheumatoid arthritis or ankylosing spondylitis;
• Vitamin D deficiency;

• Ambulatory postmenopausal women with osteoporosis aged 60-90 years (both inclusive);
• Postmenopausal, defined as \> 2 years of menopause, i.e., \> 2 years of spontaneous amenorrhea or \> 2 years after bilateral oophorectomy;
• Bone mineral density (BMD) T-score between -2.5 and -4.0 at the lumbar spine or total hip, i.e., -4.0 \< T-score ≤ -2.5, as assessed by the central imaging vendor at the time of screening, based on dual-energy x-ray absorptiometry (DXA) scans;
• At least 2 vertebrae in the L1-L4 region of lumbar spine and at least one hip are evaluable by DXA, assessed by the central imaging