Efficacy of Denosumab on Bisphosphonate-treated Osteoporosis and Osteopenia in Systemic Rheumatic Disease Patients Receiving Glucocorticoids

Overview

Journal J Bone Miner Metab

Specialty Endocrinology

Date 2022 Dec 13

PMID 36512086

Authors

Shin-Ya Tamechika

Shin-Ichiro Ohmura

Shinji Maeda

Taio Naniwa

Affiliations

Soon will be listed here.

Abstract

Introduction: Evidence on second-line agents for osteoporosis and osteopenia associated with glucocorticoid use after first-line bisphosphonate therapy is limited. We, therefore, examine the efficacy of denosumab on bisphosphonate-treated osteoporosis and osteopenia in Japanese systemic rheumatic disease (SRD) patients receiving glucocorticoids.

Materials And Methods: Glucocorticoid-treated SRD patients with a pre-existing fragility fracture, either lumbar spine (LS) or femoral neck (FN) bone mineral density (BMD) T-score of ≤ -2.5 or of ≤ -1.5 without a significant increase in BMD in the past year despite oral bisphosphonate therapy were enrolled in this study. They were randomized to switch to 60 mg subcutaneous denosumab every six months (switching group) or to continue the bisphosphonate (continuing group). The primary endpoint was the percent change from baseline in BMD at the LS and FN at week 52.

Results: Of the 39 subjects, 19 were assigned to the switching group and 20 to the continuing group. The switching group showed significant increases in LS BMD (5.7% vs. 1.1%, p = 0.002) and FN BMD (4.2% vs. -0.3%, p = 0.008) at week 52 than the continuing group, with a significant decrease in serum tartrate-resistant acid phosphatase 5b (-28.1% vs. 7.0%, p < 0.001) and improved patient satisfaction.

Conclusion: Switching to denosumab demonstrated greater efficacy than continuing bisphosphonates in increasing BMD, inhibiting osteoclast activation, and enhancing patient satisfaction in Japanese bisphosphonate-treated osteoporosis and osteopenia patients with concomitant SRD receiving glucocorticoids.

Citing Articles

Superiority of denosumab over bisphosphonates in preventing and treating glucocorticoid-induced osteoporosis: a systematic review and meta-analysis with GRADE quality assessment.

Chen C, Wang J Front Endocrinol (Lausanne). 2025; 15():1407692.

PMID: 39744180 PMC: 11688227. DOI: 10.3389/fendo.2024.1407692.

References

Curtis J, Saag K . Prevention and treatment of glucocorticoid-induced osteoporosis. Curr Osteoporos Rep. 2007; 5(1):14-21. DOI: 10.1007/BF02938618. View

van Staa T . The pathogenesis, epidemiology and management of glucocorticoid-induced osteoporosis. Calcif Tissue Int. 2006; 79(3):129-37. DOI: 10.1007/s00223-006-0019-1. View

Lems W . Bisphosphonates and glucocorticoids: effects on bone quality. Arthritis Rheum. 2007; 56(11):3518-22. DOI: 10.1002/art.22975. View

Saag K . Glucocorticoid-induced osteoporosis. Endocrinol Metab Clin North Am. 2003; 32(1):135-57, vii. DOI: 10.1016/s0889-8529(02)00064-6. View

van Staa T, Leufkens H, Abenhaim L, Zhang B, Cooper C . Use of oral corticosteroids and risk of fractures. J Bone Miner Res. 2000; 15(6):993-1000. DOI: 10.1359/jbmr.2000.15.6.993. View

Vestergaard P, Olsen M, Paaske Johnsen S, Rejnmark L, Sorensen H, Mosekilde L . Corticosteroid use and risk of hip fracture: a population-based case-control study in Denmark. J Intern Med. 2003; 254(5):486-93. DOI: 10.1046/j.1365-2796.2003.01219.x. View

Curtis J, Westfall A, Allison J, Bijlsma J, Freeman A, George V . Population-based assessment of adverse events associated with long-term glucocorticoid use. Arthritis Rheum. 2006; 55(3):420-6. DOI: 10.1002/art.21984. View

Angeli A, Guglielmi G, Dovio A, Capelli G, de Feo D, Giannini S . High prevalence of asymptomatic vertebral fractures in post-menopausal women receiving chronic glucocorticoid therapy: a cross-sectional outpatient study. Bone. 2006; 39(2):253-9. DOI: 10.1016/j.bone.2006.02.005. View

Buckley L, Guyatt G, Fink H, Cannon M, Grossman J, Hansen K . 2017 American College of Rheumatology Guideline for the Prevention and Treatment of Glucocorticoid-Induced Osteoporosis. Arthritis Care Res (Hoboken). 2017; 69(8):1095-1110. DOI: 10.1002/acr.23279. View

10.

Suzuki Y, Nawata H, Soen S, Fujiwara S, Nakayama H, Tanaka I . Guidelines on the management and treatment of glucocorticoid-induced osteoporosis of the Japanese Society for Bone and Mineral Research: 2014 update. J Bone Miner Metab. 2014; 32(4):337-50. DOI: 10.1007/s00774-014-0586-6. View

11.

Lekamwasam S, Adachi J, Agnusdei D, Bilezikian J, Boonen S, Borgstrom F . A framework for the development of guidelines for the management of glucocorticoid-induced osteoporosis. Osteoporos Int. 2012; 23(9):2257-76. DOI: 10.1007/s00198-012-1958-1. View

12.

Saag K, Wagman R, Geusens P, Adachi J, Messina O, Emkey R . Denosumab versus risedronate in glucocorticoid-induced osteoporosis: a multicentre, randomised, double-blind, active-controlled, double-dummy, non-inferiority study. Lancet Diabetes Endocrinol. 2018; 6(6):445-454. DOI: 10.1016/S2213-8587(18)30075-5. View

13.

Saag K, Pannacciulli N, Geusens P, Adachi J, Messina O, Morales-Torres J . Denosumab Versus Risedronate in Glucocorticoid-Induced Osteoporosis: Final Results of a Twenty-Four-Month Randomized, Double-Blind, Double-Dummy Trial. Arthritis Rheumatol. 2019; 71(7):1174-1184. PMC: 6619388. DOI: 10.1002/art.40874. View

14.

Mok C, Ho L, Ma K . Switching of oral bisphosphonates to denosumab in chronic glucocorticoid users: a 12-month randomized controlled trial. Bone. 2015; 75:222-8. DOI: 10.1016/j.bone.2015.03.002. View

15.

Suzuki T, Nakamura Y, Kato H . Significant improvement of bone mineral density by denosumab without bisphosphonate pre-treatment in glucocorticoid-induced osteoporosis. Mod Rheumatol. 2017; 28(5):885-889. DOI: 10.1080/14397595.2017.1416919. View

16.

Hirooka Y, Nozaki Y, Inoue A, Li J, Shiga T, Kishimoto K . Effects of denosumab versus teriparatide in glucocorticoid-induced osteoporosis patients with prior bisphosphonate treatment. Bone Rep. 2020; 13:100293. PMC: 7352055. DOI: 10.1016/j.bonr.2020.100293. View

17.

Tamechika S, Sasaki K, Hayami Y, Ohmura S, Maeda S, Iwagaitsu S . Patient satisfaction and efficacy of switching from weekly bisphosphonates to monthly minodronate for treatment and prevention of glucocorticoid-induced osteoporosis in Japanese patients with systemic rheumatic diseases: a randomized, clinical trial. Arch Osteoporos. 2018; 13(1):67. DOI: 10.1007/s11657-018-0451-7. View

18.

Furuta K, Adachi K, Arima N, Tanaka S, Miki M, Azumi T . [Study on the recognition of upper abdominal symptoms by Japanese adults ]. Nihon Shokakibyo Gakkai Zasshi. 2008; 105(6):817-24. View

19.

Kendler D, Roux C, Benhamou C, Brown J, Lillestol M, Siddhanti S . Effects of denosumab on bone mineral density and bone turnover in postmenopausal women transitioning from alendronate therapy. J Bone Miner Res. 2009; 25(1):72-81. DOI: 10.1359/jbmr.090716. View

20.

Matsuno H . Assessment of Distal Radius Bone Mineral Density in Osteoporosis Patients Receiving Denosumab, Including Those with Rheumatoid Arthritis and Those Receiving Oral Glucocorticoids. Drugs R D. 2016; 16(4):347-353. PMC: 5114204. DOI: 10.1007/s40268-016-0146-8. View