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