Osteoporosis Therapy With Denosumab in Organ Transplant Recipients
ObjectiveOsteoporosis and fragility fractures represent serious complications for the solid organ transplant population. The recommended osteoporosis therapy for organ recipients involves supplementation with calcium and vitamin D and bisphosphonate administration. However, these options can prove l...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2018-04-01
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| Series: | Frontiers in Endocrinology |
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| Online Access: | http://journal.frontiersin.org/article/10.3389/fendo.2018.00162/full |
| _version_ | 1819230478861860864 |
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| author | Jana Brunova Simona Kratochvilova Jitka Stepankova |
| author_facet | Jana Brunova Simona Kratochvilova Jitka Stepankova |
| author_sort | Jana Brunova |
| collection | DOAJ |
| description | ObjectiveOsteoporosis and fragility fractures represent serious complications for the solid organ transplant population. The recommended osteoporosis therapy for organ recipients involves supplementation with calcium and vitamin D and bisphosphonate administration. However, these options can prove limited for patients with impaired renal function. An alternative therapy option is offered by denosumab, a monoclonal antibody that targets receptor activator of nuclear factor kappa-B ligand.Patients and methodsWe evaluated 63 patients with osteoporosis (23 males and 40 females, age 56.4 ± 13.1 years) following solid organ transplantation (15 diabetic patients after simultaneous transplantation of the kidney and pancreas, 34 patients after kidney transplantation, and 14 patients with liver grafts). Osteoporosis was diagnosed according to standard DEXA examination using the Lunar Prodigy apparatus. Transplanted patients with impaired renal function were treated for osteoporosis of the lumbar spine (L-spine) and/or proximal femur with calcium and vitamin D supplementation and 60 mg of denosumab every 6 months between the years 2012 and 2017. The mean duration of the therapy was 1.65 ± 0.7 years.ResultsAfter denosumab therapy, L-spine T-scores improved across the whole group, ranging from −2.7 ± 0.09 to −1.8 ± 1.0 (p < 0.001). T-score values for the proximal femur increased from −2.5 ± 0.8 to −2.0 ± 0.7 after the therapy (p < 0.01). We observed only a mild, statistically insignificant improvement in distal forearm T-scores. The mean increase in L-spine bone mineral density (BMD) was 11.5 ± 6.2% in subjects with osteoporosis at this site and 10.4 ± 6.1% in the case of all patients. BMD of the proximal femur increased by 10.4 ± 8.3% in patients with osteoporosis and by 7.5 ± 7.3% in all patients. Denosumab therapy decreased the prevalence of osteoporosis in the L-spine from 75 to 27% (p < 0.001) and proximal femur osteoporosis from 54 to 36% (p < 0.05). Denosumab therapy reduced elevated levels of osteocalcin and beta-crosslaps (βCTX) in comparison with baseline levels (p < 0.001) across the whole group of graft recipients.ConclusionDenosumab therapy was well-tolerated and improved bone density in our group of solid organ transplant recipients. The indications are that denosumab could be a viable therapeutic option for transplanted patients with osteoporosis, especially in those with renal function impairment or bisphosphonate intolerance. |
| first_indexed | 2024-12-23T11:29:43Z |
| format | Article |
| id | doaj.art-46f460e46f7d4c6dbcccf73272668bda |
| institution | Directory Open Access Journal |
| issn | 1664-2392 |
| language | English |
| last_indexed | 2024-12-23T11:29:43Z |
| publishDate | 2018-04-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Endocrinology |
| spelling | doaj.art-46f460e46f7d4c6dbcccf73272668bda2022-12-21T17:48:50ZengFrontiers Media S.A.Frontiers in Endocrinology1664-23922018-04-01910.3389/fendo.2018.00162357590Osteoporosis Therapy With Denosumab in Organ Transplant RecipientsJana BrunovaSimona KratochvilovaJitka StepankovaObjectiveOsteoporosis and fragility fractures represent serious complications for the solid organ transplant population. The recommended osteoporosis therapy for organ recipients involves supplementation with calcium and vitamin D and bisphosphonate administration. However, these options can prove limited for patients with impaired renal function. An alternative therapy option is offered by denosumab, a monoclonal antibody that targets receptor activator of nuclear factor kappa-B ligand.Patients and methodsWe evaluated 63 patients with osteoporosis (23 males and 40 females, age 56.4 ± 13.1 years) following solid organ transplantation (15 diabetic patients after simultaneous transplantation of the kidney and pancreas, 34 patients after kidney transplantation, and 14 patients with liver grafts). Osteoporosis was diagnosed according to standard DEXA examination using the Lunar Prodigy apparatus. Transplanted patients with impaired renal function were treated for osteoporosis of the lumbar spine (L-spine) and/or proximal femur with calcium and vitamin D supplementation and 60 mg of denosumab every 6 months between the years 2012 and 2017. The mean duration of the therapy was 1.65 ± 0.7 years.ResultsAfter denosumab therapy, L-spine T-scores improved across the whole group, ranging from −2.7 ± 0.09 to −1.8 ± 1.0 (p < 0.001). T-score values for the proximal femur increased from −2.5 ± 0.8 to −2.0 ± 0.7 after the therapy (p < 0.01). We observed only a mild, statistically insignificant improvement in distal forearm T-scores. The mean increase in L-spine bone mineral density (BMD) was 11.5 ± 6.2% in subjects with osteoporosis at this site and 10.4 ± 6.1% in the case of all patients. BMD of the proximal femur increased by 10.4 ± 8.3% in patients with osteoporosis and by 7.5 ± 7.3% in all patients. Denosumab therapy decreased the prevalence of osteoporosis in the L-spine from 75 to 27% (p < 0.001) and proximal femur osteoporosis from 54 to 36% (p < 0.05). Denosumab therapy reduced elevated levels of osteocalcin and beta-crosslaps (βCTX) in comparison with baseline levels (p < 0.001) across the whole group of graft recipients.ConclusionDenosumab therapy was well-tolerated and improved bone density in our group of solid organ transplant recipients. The indications are that denosumab could be a viable therapeutic option for transplanted patients with osteoporosis, especially in those with renal function impairment or bisphosphonate intolerance.http://journal.frontiersin.org/article/10.3389/fendo.2018.00162/fullosteoporosisdenosumabsolid organ transplantationmonoclonal antibodydual energy X-ray absorptiometry |
| spellingShingle | Jana Brunova Simona Kratochvilova Jitka Stepankova Osteoporosis Therapy With Denosumab in Organ Transplant Recipients Frontiers in Endocrinology osteoporosis denosumab solid organ transplantation monoclonal antibody dual energy X-ray absorptiometry |
| title | Osteoporosis Therapy With Denosumab in Organ Transplant Recipients |
| title_full | Osteoporosis Therapy With Denosumab in Organ Transplant Recipients |
| title_fullStr | Osteoporosis Therapy With Denosumab in Organ Transplant Recipients |
| title_full_unstemmed | Osteoporosis Therapy With Denosumab in Organ Transplant Recipients |
| title_short | Osteoporosis Therapy With Denosumab in Organ Transplant Recipients |
| title_sort | osteoporosis therapy with denosumab in organ transplant recipients |
| topic | osteoporosis denosumab solid organ transplantation monoclonal antibody dual energy X-ray absorptiometry |
| url | http://journal.frontiersin.org/article/10.3389/fendo.2018.00162/full |
| work_keys_str_mv | AT janabrunova osteoporosistherapywithdenosumabinorgantransplantrecipients AT simonakratochvilova osteoporosistherapywithdenosumabinorgantransplantrecipients AT jitkastepankova osteoporosistherapywithdenosumabinorgantransplantrecipients |