Abstract
BackgroundDenosumab is a major treatment option for patients with postmenopausal osteoporosis; however, the evidence for its use is lacking. Therefore, in this 24-month retrospective study, we aimed to evaluate the effects of switching from minodronate (MIN) to denosumab in these patients.MethodsPatients with postmenopausal osteoporosis either switched from MIN to denosumab (Group 1; n = 32) or continued MIN treatment (Group 2; n = 24). Bone mineral density (BMD) of the lumbar spine (L2–L4) and femoral neck was assessed at baseline and every 6 months for 24 months. Serum bone-specific alkaline phosphatase (BAP) and N-terminal telopeptide were measured at baseline, 12 months, and 24 months.ResultsTwenty-nine of the 32 patients (90.6%) in group 1 and all patients (24/24) in group 2 completed the 24-month follow-up. Switching from MIN to denosumab (Group 1) significantly increased lumbar BMD at 12, 18, and 24 months (6.1, 7.4, and 9.6%, respectively) and femoral neck BMD at 12, 18, and 24 months (2.8, 3.2, and 3.4%, respectively), whereas MIN continuous treatment (Group 2) showed no significant difference from baseline. Switching therapy also showed a significant decrease in serum BAP from baseline to 12 and 24 months (− 19.3 and − 26.5%, respectively) and serum NTX from baseline to 12 months (− 13.1%), whereas continuous MIN treatment failed to show any significant differences from baseline.ConclusionSwitching from MIN to denosumab in patients with postmenopausal osteoporosis showed clinical benefits with regard to BMD and bone turnover markers in comparison with continuous MIN treatment. It may therefore be a valid treatment option in the clinical setting.
Highlights
Denosumab is a major treatment option for patients with postmenopausal osteoporosis; the evidence for its use is lacking
Subjects were excluded for the following reasons: 1) hypocalcemia, 2) severe diabetes, 3) thyroid or parathyroid disease, 4) hepatic disease, 5) malignant disease, 6) hormone replacement therapy, 7) significantly impaired renal function, 8) hypersensitivity to denosumab, 9) concomitant use of other agents for osteoporosis, 10) concomitant use of agents potentially affecting bone turnover, and 11) inappropriate to participate in the study for other reasons
Serum calcium concentrations of the subject who experienced repeated leg cramps was 9.4 and 9.2 mg/dl. In this retrospective study, switching from MIN to denosumab significantly increased lumbar bone mineral density (BMD) (9.6% at 24 months) and femoral neck BMD (3.4% at 24 months), with a certain decrease in bone turnover markers. This indicates that instead of continuing with MIN, patients could switch to denosumab, which is more effective at improving BMD
Summary
Denosumab is a major treatment option for patients with postmenopausal osteoporosis; the evidence for its use is lacking. 20–50% patients with hip fracture suffer from a decreased quality of life, depression, loss of selfesteem, and social isolation, which leads to the drastic elevation of one-year mortality rate, up to 14–60% [4,5,6,7]. Lumbar fractures may cause gastrointestinal complaints, back pain (both, acute and chronic), depression, and positional restriction, resulting in increased mortality [7, 8]. In view of these numerous complications, the main objective of treating postmenopausal osteoporosis is the prevention of future fractures
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