Hypocalcemia and Bone Mineral Density Changes Following Denosumab Treatment in End-Stage Renal Disease Patients: A Meta-Analys

National Kidney Foundation

Source Reference: Acharya P, et al “Hypocalcemia and bone mineral density changes following denosumab treatment in end-stage renal disease patients: a meta-analysis” NKF 2018; Abstract 164.

INTRODUCTION

The incidence of hypocalcemia and bone mineral density (BMD) changes in end stage renal disease (ESRD) patients on denosumab remains unclear. We performed this meta-analysis to assess the incidence of denosumab-assocociated hypocalcemia and effects of denosumab on BMD in ESRD patients

METHODS

A literature search was conducted using MEDLINE, EMBASE and Cochrane Database from inception through October 2017 to identify studies evaluating incidence of denosumab-associated hypocalcemia, and changes in serum calcium, phosphate, alkaline phosphatase (ALP), parathyroid hormone (PTH), and BMD from baseline to post-treatment course of denosumab in ESRD patients. Study results were pooled and analyzed using a random effects model

RESULTS

6 observational studies with a total of 84 ESRD patients were enrolled. The pooled estimated incidence of hypocalcemia during denosumab treatment was 42% (95%CI: 29%-55%, I2=0%). However, there were no significant changes in serum calcium or phosphate from baseline to post-treatment course (>/=3 months after treatment) with mean differences [MDs] of 0.20 mg/dL (95% CI, -0.30 to 0.69 mg/dL) and -0.10 mg/dL (95% CI, -0.70 to 0.49 mg/dL). There were significant reductions in ALP and PTH levels with standardized mean differences (SMDs) of -0.65 (95% CI -1.13 to -0.16) and -1.89 (95% CI -3.44 to -0.34) respectively. There were significant increase in T scores with MDs of 0.39 (95% CI 0.10 to 0.69) and 0.79 (95% CI 0.60 to 0.98) for lumbar spine and femoral neck, respectively

CONCLUSION

Our study demonstrates the estimated incidence of denosumab associated-hypocalcemia in dialysis patients of 42%. From baseline to post-treatment course, although there are no differences in serum calcium and phosphate, our findings suggest significant reductions in ALP and PTH, and a significant increase in BMD.

Learning objectives:

  1. Assess the incidence of Denosumab associated hypocalcemia in patients on dialysis
  2. Evaluate effects of Denosumab on bone mineral density in patients on dialysis
  3. Evaluate effects of Denosumab on changes in the calcium, phosphate, alkaline phosphatase (ALP), parathyroid hormone (PTH) in patients on dialysis

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