The Effect of Denosumab in Elderly Patients Regarding Bone Density and Fracture Risk

Abstract

Background: With an aging population, the importance of treating and diagnosing osteoporosis is increasing. Osteoporosis, previously known as a resorptive change primarily related to endocrinological mechanisms, is also being approached as a phenomenon of senile change. Denosumab is gaining popularity among osteoporosis medications due to its ability to increase bone mineral density (BMD) and the economic benefit arising from the 6-month cycle. In line with previous literature, this study aimed to examine the BMD-augmenting effect of denosumab through which it reduces fracture risk in individuals aged over 80 years.

Methods: We reviewed patients who received denosumab between 2018 and 2022 with a minimum clinical observation period of 12 months. BMD was measured every 12 months, and patients were classified per their period of denosumab use. Fracture risk was evaluated using the fracture risk assessment tool (FRAX) and fracture incidence during the observation period were assessed.

Results: Among 155 patients, a significant increase in BMD was observed at 3 sites: the lumbar spine, femoral neck, and total hip (p<0.001, p<0.001, and p=0.001, respectively). The patients were divided according to the length of clinical follow-up they received, and similar results were found in all subgroups. Fracture risk assessment was performed using FRAX and the incidence of fracture events during follow-up. FRAX significantly decreased in all subgroups except those who received 24 months of follow-up (p=0.003, p=0.41, p=0.001 in the 12, 24, and ≥36 months groups, respectively).

Conclusions: Denosumab use resulted in long-term BMD increase and reduced fracture risk in individuals aged 80 and above.

Keywords: Aged; Denosumab; Fractures, bone; Osteoporosis.

Fig. 1

(A, B) Change in bone mineral density in the total patient group (N=155) and in those who had no previous experience of osteoporosis treatment (N=123). Analysis was performed using a linear mixed model. Sites included the lumbar spine (P=0.000), femoral neck (P=0.000), and total hip (P<0.001).

Fig. 2

(A–F) Bone mineral density was observed and compared in 6 separate groups. Patients were assigned to each group based on their length of clinical follow-up and their previous experience with osteoporosis treatment

Fig. 3

(A, B) The fracture risk assessment tool was calculated and compared in each group. Scores decreased in every group with statistically significant decreases in the 12 months and ≥36 months groups (P=0.003, P=0.001). The decrease was not significant in the 24 months group (P=0.410).

Fig. 4

(A, B) Fracture incidence during the follow-up period was calculated for every group.