Meta-analysis supports efficacy of denosumab for glucocorticoid-induced osteoporosis
medwireNews: Denosumab significantly increases bone mineral density (BMD) in people with glucocorticoid-induced osteoporosis and may be more effective than bisphosphonates, show the results of a systematic review and meta-analysis.
BMD increases were observed by 6 months at the lumbar spine and total hip and by 12 months at the femoral neck, report Yuta Yamaguchi and colleagues from Osaka University Graduate School of Medicine in Suita, Japan, in Rheumatology Advances in Practice.
Yamaguchi and team reviewed data from seven studies including individuals undergoing treatment with the anti-RANKL antibody denosumab. Among the trials, the mean daily dosage of corticosteroids ranged from 4.6 to 12.3 mg, while the mean duration of use was between 3.2 and 17.4 years. Denosumab was typically given at a dose of 60 mg but one study also used 180 mg.
The researchers found that treatment with denosumab resulted in a significant 2.99% mean increase in BMD in the lumbar spine from baseline to 6 months and a significant 4.59% mean increase at 12 months.
For total hip, there were significant 1.34% and 2.16% mean increases in BMD at 6 and 12 months, respectively, and at the femoral neck the increases were a nonsignificant 0.12% at 6 months and a significant 1.55% at 12 months.
This suggests “that improvements in BMD at femoral neck may require a longer therapeutic course than is required for similar improvements to be detected in the lumbar spine and total hip,” Yamaguchi et al remark.
Three studies compared the effect of denosumab with that of bisphosphonates on the lumbar spine. The meta-analysis of these studies showed that the mean increase in BMD was a significant 1.43% higher with denosumab than with bisphosphonates at 6 months and a significant 2.17% higher at 12 months.
For the femoral neck, there were two studies comparing the two treatments at 6 months and three comparing them at 12 months. At 6 months, there was no significant difference in the change in BMD between patients treated with denosumab and those treated with bisphosphonates but at 12 months the change was a significant 0.97% higher with denosumab.
Yamaguchi et al say: “Although there are still problems with denosumab treatment, such as long term efficacy and complications (risk of atypical fracture and jaw necrosis), we conclude that denosumab is [an] effective treatment for [glucocorticoid-induced osteoporosis].”
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