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The effect of previous treatment with bisphosphonate and renal impairment on the response to denosumab in osteoporosis: a 'real-life' study.
Journal of Endocrinological Investigation ( IF 3.9 ) Pub Date : null , DOI: 10.1007/s40618-019-01131-5
T R Fraser 1, 2 , I Flogaitis 1, 2 , A E Moore 2 , G Hampson 1, 2, 3
Affiliation  

PURPOSE To investigate changes in bone mineral density (BMD) following denosumab after previous bisphosphonate therapy and the impact of chronic kidney disease (CKD) on response. METHODS A retrospective study of 134 patients (11 M, 123 F) aged [mean (SD)] 72 [11] years on denosumab was undertaken. Ninety-five patients had previously been on oral and 28 on iv bisphosphonate. Lumbar spine (LS), total hip (TH) and femoral neck (FN) BMD were measured before treatment and at 2.7 [1.2] years. GFR was < 35 ml/min in 24 patients (18%). Ninety-four (18 M, 76 F) patients aged 71 [11] years transitioning to zoledronate were also studied. RESULTS BMD improved following denosumab [mean (SEM) % change LS: 6.0 (0.62) p < 0.001, TH: 2.28 (0.64) p < 0.001, FN: 1.9 (0.77) p = 0.045]. Changes at the TH and FN were lower in patients with GFR < 35 ml/min (Group B) compared to those with GFR > 35 ml/min (Group A) [% change TH; Group A: 2.9 (0.72), Group B: - 0.84 (1.28), p = 0.015, FN; Group A: 2.76 (0.86), Group B: - 1.47 (1.53), p = 0.025]. % change in BMD at the FN and PTH were negatively associated (r = - 0.25, p = 0.013). BMD changes were not different at 12-18 months between patients on denosumab compared to zoledronate [% change at LS: denosumab: 3.97% (0.85), zoledronate: 2.6% (0.5), p = 0.19 TH: denosumab: 0.97% (0.58), zoledronate: 0.92% (0.6), p = 0.95). CONCLUSION Denosumab increases BMD following previous bisphosphonate treatment and is comparable to zoledronate. Lower response seen at the hip in CKD is related to PTH concentrations.

中文翻译:

先前用双膦酸盐治疗和肾功能损害对骨质疏松症中地诺塞麦反应的影响:“现实生活”研究。

目的 研究先前双膦酸盐治疗后狄诺塞麦后骨矿物质密度 (BMD) 的变化以及慢性肾病 (CKD) 对反应的影响。方法 对 134 名 [平均 (SD)] 72 [11] 岁使用狄诺塞麦的患者 (11 M, 123 F) 进行回顾性研究。95 名患者以前口服过双膦酸盐,28 名患者使用过静脉注射双膦酸盐。在治疗前和 2.7 [1.2] 年时测量腰椎 (LS)、全髋 (TH) 和股骨颈 (FN) BMD。24 名患者 (18%) 的 GFR < 35 ml/min。还研究了 94 名 (18 M, 76 F) 年龄为 71 [11] 岁的过渡到唑来膦酸盐的患者。结果 狄诺塞麦后 BMD 得到改善 [平均 (SEM) % 变化 LS: 6.0 (0.62) p < 0.001, TH: 2.28 (0.64) p < 0.001, FN: 1.9 (0.77) p = 0.045]。GFR < 患者的 TH 和 FN 变化较低 35 ml/min(B 组)与 GFR > 35 ml/min(A 组)的比较 [% 变化 TH;A 组:2.9 (0.72),B 组:- 0.84 (1.28),p = 0.015,FN;A 组:2.76 (0.86),B 组:- 1.47 (1.53),p = 0.025]。FN 和 PTH 的 BMD 变化百分比呈负相关(r = - 0.25,p = 0.013)。与唑来膦酸相比,狄诺塞麦患者在 12-18 个月时的 BMD 变化没有差异 [LS 变化百分比:狄诺单抗:3.97% (0.85),唑来膦酸:2.6% (0.5),p = 0.19 TH:地诺单抗:0.97% (0.58) ),唑来膦酸盐:0.92% (0.6),p = 0.95)。结论 狄诺塞麦在先前的双膦酸盐治疗后增加了 BMD,并且与唑来膦酸盐相当。CKD 患者髋部反应较低与 PTH 浓度有关。A 组:2.76 (0.86),B 组:- 1.47 (1.53),p = 0.025]。FN 和 PTH 的 BMD 变化百分比呈负相关(r = - 0.25,p = 0.013)。与唑来膦酸相比,狄诺塞麦患者在 12-18 个月时的 BMD 变化没有差异 [LS 变化百分比:狄诺单抗:3.97% (0.85),唑来膦酸:2.6% (0.5),p = 0.19 TH:地诺单抗:0.97% (0.58) ),唑来膦酸盐:0.92% (0.6),p = 0.95)。结论 狄诺塞麦在先前的双膦酸盐治疗后增加了 BMD,并且与唑来膦酸盐相当。CKD 患者髋部反应较低与 PTH 浓度有关。A 组:2.76 (0.86),B 组:- 1.47 (1.53),p = 0.025]。FN 和 PTH 的 BMD 变化百分比呈负相关(r = - 0.25,p = 0.013)。与唑来膦酸相比,狄诺塞麦患者在 12-18 个月时的 BMD 变化没有差异 [LS 变化百分比:狄诺单抗:3.97% (0.85),唑来膦酸:2.6% (0.5),p = 0.19 TH:地诺单抗:0.97% (0.58) ),唑来膦酸盐:0.92% (0.6),p = 0.95)。结论 狄诺塞麦在先前的双膦酸盐治疗后增加了 BMD,并且与唑来膦酸盐相当。CKD 患者髋部反应较低与 PTH 浓度有关。唑来膦酸:2.6% (0.5),p = 0.19 TH:地诺单抗:0.97% (0.58),唑来膦酸:0.92% (0.6),p = 0.95)。结论 狄诺塞麦在先前的双膦酸盐治疗后增加了 BMD,并且与唑来膦酸盐相当。CKD 患者髋部反应较低与 PTH 浓度有关。唑来膦酸:2.6% (0.5),p = 0.19 TH:地诺单抗:0.97% (0.58),唑来膦酸:0.92% (0.6),p = 0.95)。结论 狄诺塞麦在先前的双膦酸盐治疗后增加了 BMD,并且与唑来膦酸盐相当。CKD 患者髋部反应较低与 PTH 浓度有关。
更新日期:2020-03-12
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