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Denosumab for dialysis patients with osteoporosis: A cohort study

Kyohei Kunizawa1,2, Rikako Hiramatsu1, Junichi Hoshino3,4,5

  • 1Nephrology Center, Toranomon Hospital Kajigaya, Kanagawa, Japan.

Scientific Reports
|February 14, 2020
PubMed

Insights

Denosumab showed similar bone mineral density improvements in hemodialysis (HD) and non-HD patients. However, HD patients had a higher risk of hypocalcemia, requiring careful monitoring post-treatment.

Area of Science:

  • Nephrology
  • Endocrinology
  • Bone Metabolism

Background:

  • Limited evidence exists on denosumab's efficacy in hemodialysis (HD) patients.
  • Denosumab is a monoclonal antibody targeting RANKL, used for osteoporosis and bone metastases.

Purpose of the Study:

  • To evaluate the safety and efficacy of denosumab in HD patients compared to non-HD patients.
  • To assess changes in bone mineral density (BMD) and bone metabolic markers.
  • To identify potential side effects, particularly hypocalcemia.

Main Methods:

  • Prospective study of 324 patients (121 HD, 203 non-HD) receiving denosumab from June 2013 to May 2018.
  • Assessed annual changes in BMD at lumbar spine, femoral neck, and distal radius.
  • Monitored bone metabolic markers and adverse events, focusing on hypocalcemia.

Main Results:

  • No significant difference in annual BMD changes between HD and non-HD patients at lumbar spine, femoral neck, or distal radius.
  • Significantly higher prevalence of hypocalcemia in HD patients (35.6%) compared to non-HD patients (5.4%).
  • Hypocalcemia in HD patients occurred median 7 days post-injection; greater calcium decrease observed with higher TRACP5b, corticosteroid use, and no CaCO3 supplementation.

Conclusions:

  • Denosumab demonstrates comparable efficacy in improving BMD for both HD and non-HD patients.
  • HD patients require vigilant hypocalcemia monitoring for at least 4 weeks after denosumab administration.
  • Risk factors for hypocalcemia in HD patients include higher TRACP5b, corticosteroid use, and lack of calcium supplementation.

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