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. 2018 Dec 18:15:15-22.
doi: 10.2147/TCRM.S182858. eCollection 2019.

Calcium and vitamin D supplementation with 3-year denosumab treatment is beneficial to enhance bone mineral density in postmenopausal patients with osteoporosis and rheumatoid arthritis

Takako Suzuki  1 , Yukio Nakamura  1   2 , Hiroyuki Kato  1
Affiliations

Calcium and vitamin D supplementation with 3-year denosumab treatment is beneficial to enhance bone mineral density in postmenopausal patients with osteoporosis and rheumatoid arthritis

Takako Suzuki et al. Ther Clin Risk Manag. .

Abstract

Background: This 3-year retrospective study compared the outcomes of bisphosphonate-pretreated denosumab therapy with or without vitamin D and calcium supplementation in postmenopausal osteoporosis (OP) patients with rheumatoid arthritis (RA).

Materials and methods: Fifty-eight patients under long-term denosumab treatment were divided into groups without (denosumab group; 31 cases) or with (combination group; 27 cases) vitamin D and calcium supplementation. The bone markers of BAP, TRACP-5b, and urinary NTX were measured at baseline and every year for 3 years. We also evaluated bone mineral density (BMD) of the lumbar 1-4 vertebrae (L-BMD) and bilateral total hips (H-BMD) at the same time points.

Results: There were no significant differences in the percent changes of serum albumin-corrected calcium between the groups. The percent change in TRACP-5b was significantly higher in the combination group at 2 years. Serum 25-hydroxyvitamin D status was persistently high during therapy in both groups, with significant percent increases over baseline at 2 and 6 months in both groups and at 24 months in the combination group. The percent increase from baseline of serum zinc was significantly higher at 3 years in the combination group over the denosumab group. L-BMD and H-BMD were significantly increased at every time point for 3 years vs pretreatment levels in both groups and were significantly higher in the combination group at all time points.

Conclusion: Compared with denosumab monotherapy, the combination group displayed significantly increased serum zinc, L-BMD, and H-BMD at 3 years in OP patients with RA. Thus, calcium and vitamin D supplementation may be beneficial to enhance BMD gains, but not necessarily 25-hydroxyvitamin D status, in patients with OP and RA under denosumab.

Keywords: 25(OH)D; bone mineral density; bone-related minerals; denosumab; osteoporosis; rheumatoid arthritis.

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Conflict of interest statement

Disclosure The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Percent changes of serum albumin-corrected calcium (Ca) (A), serum phosphorus (B), whole parathyroid hormone (PTH) (C), and serum 1,25(OH)2D3 (D) at 12, 24, and 36 months (M). Circles show the denosumab group and triangles show the combination group.
Figure 2
Figure 2
Percent changes of serum zinc (A), serum iron (B), and serum magnesium (C) at 12, 24, and 36 months (M). Notes: Circles show the denosumab group and triangles show the combination group. Single and double asterisks indicate a significant difference (P<0.01 and P<0.05, respectively) with baseline values.
Figure 3
Figure 3
Percent changes of serum tartrate-resistant acid phosphatase (TRACP)-5b (A), urinary cross-linked N-terminal telopeptide of type I collagen (NTX) (B), serum bone alkaline phosphatase (BAP) (C), and serum 25-hydroxyvitamin D (25(OH)D) (D) at 12, 24, and 36 months (M). Circles show the denosumab group and triangles show the combination group. Notes: Double hashtags indicate a significant difference (P<0.01) between the denosumab and combination groups. Single and double asterisks indicate a significant difference (P<0.05 and P<0.01, respectively) with baseline values.
Figure 4
Figure 4
Percent changes in lumbar bone mineral density (L-BMD) (A) and bilateral total hip BMD (H-BMD) (B) at 12, 24, and 36 months (M). Notes: Single and double hashtags indicate a significant difference (P<0.05 and P<0.01, respectively) between the denosumab and combination groups. Double asterisks indicate a significant difference (P<0.01) with baseline values.
See this image and copyright information in PMC

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