Osteoporosis: denosumab improves BMD in patients previously treated with bisphosphonate

  • Fraser TR & al.
  • J Endocrinol Invest
  • 29 Oct 2019

  • curated by Sarfaroj Khan
  • UK Clinical Digest
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Takeaway

  • Treatment with denosumab improves bone mineral density (BMD) in patients previously treated with bisphosphonates and is comparable to zoledronate.
  • The skeletal response in patients with chronic kidney disease (CKD) stage IV is significantly lower at the hip and is mainly associated with parathyroid hormone (PTH) concentrations.

Why this matters

  • The study findings suggest that elevated PTH concentrations may impair the response to denosumab at the hip sites in patients with CKD.

Study design

  • Study of 134 patients (11 males, 123 females) who had started treatment with denosumab for osteoporosis following treatment with bisphosphonates during 2013-2017.
  • Patients on denosumab were divided into 2 groups based on their estimated glomerular filtration rate (eGFR) when bisphosphonates were contra-indicated:
    • group A (n=105) with eGFR >35 mL/minute and
    • group B (n=24) with eGFR
  • 95 patients had previously been on oral and 28 on IV bisphosphonate.
  • Outcome: changes in BMD.
  • Funding: None disclosed.

Key results

  • Overall, 127 (95%) patients had sustained ≥1 fragility fractures.
  • Significant increase in BMD was observed following denosumab (mean [SEM] % change at):
    • lumbar spine (LS): 6% (0.62); P<.001>
    • total hip (TH): 2.3% (0.64); P<.001 and>
    • femoral neck (FN): 1.9% (0.77); P<.001.>
  • Changes at the TH and FN were lower in Group B vs Group A (% change at):
    • TH: 2.9% (0.72) vs −0.84% (1.28); P=.015 and
    • FN: 2.76% (0.86) vs −1.47% (1.53); P=.025.
  • Changes in BMD were significantly lower at the hip sites in patients on denosumab with GFR 35 mL/minute (P<.05>
  • % change in BMD at the FN and PTH were negatively associated in the group who transitioned to denosumab (r=−0.25; P=.013).
  • BMD changes were not different at 12-18 months between patients on denosumab vs zoledronate (% change at):
    •  LS: 3.97% (0.85) vs 2.6% (0.5); P=.19 and
    •  TH: 0.97% (0.58) vs 0.92% (0.6); P=.95.

Limitations

  • Retrospective design.
  • Absence of treatment-naïve group as control.