Changes in Bone Quality after Treatment with Etelcalcetide.

Area of Science:

• Nephrology
• Endocrinology
• Bone Metabolism

Background:

• Secondary hyperparathyroidism is a common complication in patients undergoing hemodialysis, often associated with osteoporosis and increased fracture risk.
• Etelcalcetide is an approved intravenous calcimimetic agent used to manage hyperparathyroidism in this patient population.
• The skeletal effects of etelcalcetide, particularly on bone quality and strength, remained largely unknown prior to this study.

Purpose of the Study:

• To investigate the effects of etelcalcetide on bone quality and strength in patients on hemodialysis.
• To assess whether etelcalcetide treatment improves bone mineral density and microarchitecture without compromising bone-tissue quality.

Main Methods:

• A 36-week, single-arm, open-label prospective trial was conducted.
• Participants included adults on hemodialysis for at least one year with no recent calcimimetic exposure.
• Measurements included areal bone mineral density (DXA), trabecular bone score, high-resolution peripheral quantitative CT, and bone biopsy for tissue quality assessment.

Main Results:

• Etelcalcetide treatment led to a significant reduction in parathyroid hormone levels (67%).
• Improvements were observed in central skeleton bone mineral density (spine, hip) and trabecular bone score.
• Radius stiffness and failure load showed a trend towards increase, while bone formation rate decreased, indicating lower bone turnover.

Conclusions:

• Treatment with etelcalcetide for 36 weeks improved bone mineral density and trabecular quality in the central skeleton.
• The study demonstrated that etelcalcetide lowers bone turnover without adversely affecting bone material properties.
• These findings suggest a potential benefit of etelcalcetide on skeletal health in patients with secondary hyperparathyroidism on hemodialysis.