Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Aug 29;19(8):e0309657.
doi: 10.1371/journal.pone.0309657. eCollection 2024.

Effect of denosumab on the incidence of fractures and mortality in patients undergoing hemodialysis: A retrospective cohort study

Arisa Kobayashi  1   2 , Tatsuhiro Yaginuma  3 , Kazuhiko Kato  1 , Akio Nakashima  1 , Ichiro Ohkido  1 , Takashi Yokoo  1
Affiliations

Effect of denosumab on the incidence of fractures and mortality in patients undergoing hemodialysis: A retrospective cohort study

Arisa Kobayashi et al. PLoS One. .

Erratum in

Abstract

Background: Patients undergoing hemodialysis are at an elevated risk of fractures; however, substantial evidence for osteoporosis treatment in this population is lacking. We explored the efficacy of denosumab, an anti-IgG2 antibody that targets the receptor activator of nuclear factor-kappa B ligand, in reducing fracture incidence and all-cause mortality in patients undergoing hemodialysis.

Methods: This retrospective cohort study-conducted from December 2013 to December 2022-evaluated the effects of denosumab on fracture incidence and all-cause mortality. Patients who initiated denosumab treatment during the study period were defined as the denosumab group, while those without a history of denosumab administration were defined as the non-denosumab group. Kaplan-Meier curves and log-rank tests were used to assess survival and fracture/mortality risks, respectively. Cox proportional hazards models were used to analyze both fractures and all-cause mortality.

Results: Among 214 patients undergoing hemodialysis, 52 (24.3%) received denosumab. The median age was 73.0 ± 11.5 years, with 92 (43.0%) females, and the median dialysis duration was 59 months (interquartile range, 6-126). During the study, thirty-seven non-denosumab-treated patients had fractures compared to eight in the denosumab group. No significant differences were observed in the unadjusted model (HR, 0.53; 95% confidence interval (CI), 0.24-1.14). Adjusting for competing mortality and clinical factors, the HR remained at 0.64 (95% CI, 0.27-1.51). Regarding all-cause mortality, we found a statistically significant difference in the unadjusted model (HR, 0.61 [95% CI, 0.38-0.98]). A significant reduction in mortality was observed in the adjusted model (HR, 0.46 [95% CI, 0.26-0.80]). Notably, the denosumab group showed a significant decrease in mortality, particularly in cardiovascular disease-related cases (HR, 0.33 [95% CI, 0.14-0.78]).

Conclusions: Denosumab may reduce all-cause mortality in patients undergoing hemodialysis, particularly in those with cardiovascular complications. This finding offers a promising direction for osteoporosis treatment in patients undergoing hemodialysis.

PubMed Disclaimer

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Kaplan–Meier curves showing the onset of fractures.
Fig 2
Fig 2. Kaplan–Meier curves for all-cause mortality.
Fig 3
Fig 3. Kaplan–Meier curve for mortality related to CVD.
Fig 4
Fig 4. Kaplan–Meier curves for mortality related to infectious disease.
See this image and copyright information in PMC

References

    1. Wakasugi M, Kazama JJ, Taniguchi M, Wada A, Iseki, Tsubakihara Y, et al.. Increased risk of hip fracture among Japanese hemodialysis patients. J Bone Miner Metab. 2013; 31:315–321. doi: 10.1007/s00774-012-0411-z - DOI - PubMed
    1. Alem AM, Sherrard DJ, Gillen DL, Weiss NS, Beresford SA, Heckbert SR, et al.. Increased risk of hip fracture among patients with end-stage renal disease. Kidney Int. 2000; 58:396–399. doi: 10.1046/j.1523-1755.2000.00178.x - DOI - PubMed
    1. Coco M, Rush H. Increased incidence of hip fractures in dialysis patients with low serum parathyroid hormone. Am J Kidney Dis. 2000; 36:1115–1121. doi: 10.1053/ajkd.2000.19812 - DOI - PubMed
    1. Wakasugi M, Kazama JJ, Wada A, Hamano T, Masakane I, Narita I. Long-term excess mortality after hip fracture in hemodialysis patients: a nationwide cohort study in Japan. J Bone Miner Metab. 2020; 38:718–729. doi: 10.1007/s00774-020-01110-4 - DOI - PubMed
    1. Orimo H, Nakamura T, Hosoi T, Iki M, Uenishi K, Endo N, et al.. Japanese 2011 guidelines for prevention and treatment of osteoporosis—executive summary. Arch Osteoporos. 2012; 7:3–20. doi: 10.1007/s11657-012-0109-9 - DOI - PMC - PubMed

MeSH terms

LinkOut - more resources