Denosumab improves bone mineral density and microarchitecture and reduces bone pain in women with osteoporosis with and without glucocorticoid treatment

Abstract

Osteoporosis is a key health problem in postmenopausal women with high social and economic impact. Decreased bone mineral density (BMD) and deterioration of bone microarchitecture may occur also as a result of long-term glucocorticoid treatment (GCT) of autoimmune or inflammatory conditions. Denosumab specifically inhibits the binding of the receptor activator of nuclear factor-κB to its ligand, thus preventing osteoclast activation and bone resorption. The efficacy and safety of denosumab, administered subcutaneously as 60 mg, once every six months for 12 months, were evaluated in 60 patients with postmenopausal osteoporosis (PMO) divided into two groups. The GCT group included 30 patients receiving concomitant glucocorticoid therapy and the non-GCT group included 30 patients that did not receive GCT. In the non-GCT group, the 12-month treatment with denosumab resulted in BMD increase of 6.1% and 2.8% in lumbar spine and hip, respectively. T-score increased by 13.1% and 5.6% in both, the lumbar spine and hip. A slight rise in the Trabecular Bone Score (TBS) of 0.3% was observed. Bone pain was markedly reduced by 56.2%. In the GCT group, denosumab therapy increased BMD with 5.8% and 2.3% in lumbar spine and hip, respectively. T-score of lumbar spine and hip significantly increased by 14.0% and 4.4%, and the TBS rose by 5%. Bone pain was reduced by 53.6%. These data confirm the available knowledge on denosumab efficacy and safety in women with PMO and also provide new insights into its therapeutic potential in patients with osteoporosis related to a long-term corticosteroid treatment.

Keywords: BMD; TBS; bone pain; denosumab; glucocorticoid treatment; postmenopausal osteoporosis.

Figure 1.

Change in BMD and T-score of lumbar spine after 12-month treatment with denosumab (non-GCT group). (A) Change in BMD. Data are presented as a comparison between mean values of BMD (g/cm²) at baseline and at the 12th month of treatment with a percent change of 6.1 and level of significance of p = 0.2. (B) Change in T-score. Comparison between mean values of T-score at baseline vs. T-score at month 12 of treatment with a significant change of 13.1%, p < 0.05.

Figure 2.

Change in BMD and T-score of lumbar spine after 12-month treatment with denosumab (GCT group). (A) Change in BMD. Data are presented as a comparison between mean values of BMD (g/cm²) at baseline and at the 12th month of treatment with a percent change of 5.8% and level of significance of p = 0.2. (B) Change in T-score. Comparison between mean values of T-score at baseline vs. T-score at month 12 of treatment with a significant change of 14.0%, p = 0.03.

Figure 3.

Change in BMD and T-score of total hip after 12-month treatment with denosumab (non-GCT group). (A) Change in BMD. Data are presented as a comparison between mean values of BMD (g/cm²) at baseline and at the 12th month of treatment with a percent change of 2.8% and level of significance of p = 0.2. (B) Change in T-score. Comparison between mean values of T-score at baseline vs. T-score at month 12 of treatment with a significant change of 5.6%, p = 0.01.

Figure 4.

Change in BMD and T-score of total hip after 12-month treatment with denosumab (GCT group). (A) Change in BMD. Data are presented as a comparison between mean values of BMD (g/cm²) at baseline and at the 12th month of treatment with a percent change of 2.3% and level of significance of p = 0.2. (B) Change in T-score. Comparison between mean values of T-score at baseline vs. T-score at month 12 of treatment with a significant change of 4.4%, p = 0.01.

Figure 5.

Effect of denosumab on TBS. (A) Non-GCT group. Comparison between mean TBS values at baseline and mean TBS values at the 12th month of denosumab therapy with a percent change of 0.3% and p = 0.1. (B) GCT group. Comparison between mean TBS values at baseline and mean TBS values at the 12th month of denosumab therapy with a percent change of 5.0% and p = 0.1.

Figure 6.

Effect of denosumab on fracture risk reduction. Data are presented as mean values (baseline and at the 12 month) of fracture risk for major osteoporotic and hip fracture, respectively, as measured by the FRAX tool. (A) Non-GCT group. (B) GCT group.

Figure 7.

Effect of denosumab on bone pain. (A) Non-GCT group. Pain levels are presented as mean values of pain scores (VAS) assessed at baseline and after 12 months of treatment with a significant change of 56.2%, p < 0.01. (B) GCT group. Pain levels are presented as mean values of pain scores (VAS) assessed at baseline and after 12 months of treatment with a significant change of 53.6%, p < 0.01.

Figure 8.

Correlation between BMD change (lumbar spine and hip) and Beta-CTx. Patients were divided into four groups on the basis of their baseline Beta-CTx measures. Data are presented as mean values of baseline Beta-CTx (per group) and mean BMD change (lumbar spine and hip, also per group) at month 12. (A) Non-GCT group. (B) GCT group.