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Lower response to denosumab in diabetes patients on hemodialysis

Seung Hyun Han, Hyung Ah Jo, Kum Hyun Han

    Clinical Nephrology
    |August 27, 2021
    PubMed

    Insights

    Denosumab improved bone density in hemodialysis patients, but with a reduced effect in those with diabetes. This study highlights the need for tailored treatment approaches for osteoporosis in this population.

    Area of Science:

    • Nephrology
    • Endocrinology
    • Orthopedics

    Background:

    • Patients with chronic kidney disease, particularly those on hemodialysis (HD), have a higher incidence of fractures.
    • Denosumab is an effective osteoporosis treatment, but its use in HD patients, especially those with diabetes, lacks clear guidelines.

    Purpose of the Study:

    • To analyze the efficacy of denosumab in treating osteoporosis in hemodialysis patients.
    • To compare the treatment response between hemodialysis patients with and without diabetes.

    Main Methods:

    • Retrospective analysis of 89 hemodialysis patients, with 42 diagnosed with osteoporosis.
    • Dual-energy X-ray absorptiometry (DXA) and bone turnover markers (CTX, bsALP) assessed before and after denosumab treatment.
    • Follow-up biomarkers measured at 6 months, and bone mineral density (BMD) at 1 year.

    Main Results:

    • Denosumab significantly improved lumbar spine (LS) and femur neck (FN) bone mineral density (BMD) by +3.40% and 4.96% respectively after 1 year.
    • Bone turnover markers, C-terminal telopeptide (CTX) and bone-specific alkaline phosphatase (bsALP), decreased significantly at 6 months.
    • The increase in LS BMD and decrease in CTX were significantly lower in the diabetes group compared to the non-diabetes group.

    Conclusions:

    • Denosumab effectively improves bone density and reduces osteoclastic activity in hemodialysis patients.
    • Patients with diabetes showed a diminished response to denosumab treatment compared to non-diabetic patients.
    • Pretreatment with calcium and calcitriol was effective in preventing hypocalcemia.
    Abstract

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