The clinical benefits of denosumab for prophylaxis of steroid-induced osteoporosis in patients with pulmonary disease

Ishiguro, S., Ito, K., Nakagawa, S. et al.

Arch Osteoporos (2017) 12: 44. doi:10.1007/s11657-017-0336-1

Abstract

Summary

Previous reports demonstrated that bone density decreased rapidly during the initial few months of steroid therapy and continued decreasing at a rate of 2 to 4% annually. Our data indicates that denosumab can also play a role in the treatment of osteoporosis in the steroid-taking population.

Introduction

Respiratory physicians are often faced with the dilemma that long-term steroid use will deteriorate bone mineral density and quality. Previous reports demonstrated that bone density decreased 8 to 12% during the initial few months of steroid therapy then continued decreasing at a rate of 2 to 4% annually. Several prospective trials revealed that denosumab increased bone density in patients with osteoporosis [2, 3, 4] and decreased the rate of occurrence of fractures. The long-term efficacy of denosumab for glucocorticoid-induced osteoporosis, however, has not yet been proven.

Materials

This has been an ongoing prospective study since 2014. In our respiratory centre, the first preventative measure used to combat glucocorticoid-induced osteoporosis (GIO) is oral bisphosphonates. Thirty-six patients were enlisted, and their treatment courses were changed from oral bisphosphonate, if administered, to the subcutaneous injection of denosumab 60 mg every 6 months, combined with a daily oral intake of DENOTAS® chewable combination tablets. The primary efficacy measures were changes in lumbar spine (LS) bone mineral density (BMD) and femoral BMD from baseline at 4, 8, 12 and 28 months.

Results

At the 12-month follow-up, bone mineral density in the lumbar spine area of these patients increased by 3.2%, while bone mineral density in the hip area showed no significant increase. At the 28-month follow-up, 25 patients were still included in this study. Femoral BMD at 28 months increased significantly from the 12-month follow-up (P = 0.0259), though the first 12 months showed no significant increase. LS BMD continued to increase through the 28-month period.

Conclusions

 

Very little is known regarding the active prevention of GIO. Our data indicates that denosumab can play a promising role in the treatment of GIO.

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