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Updated: Sep 16, 2025
A Semi-Automated and Reproducible Biological-Based Method to Quantify Calcium Deposition In Vitro
Published on: June 2, 2022
Denosumab associated with accelerated progression of abdominal aortic calcification among patients on dialysis
Tetsuya Seto1,2,3, Kiminori Yukata2, Zenzo Fujii4
1Department of Orthopedic Surgery, St. Hill Hospital, Yamaguchi 755-0155, Japan.
Abstract:
Chronic kidney disease (CKD) is associated with disturbances in bone and mineral metabolism, leading to osteoporosis and vascular calcification, which are significant contributors to mortality. Although denosumab, a monoclonal antibody targeting RANKL, has been shown to increase BMD, its effects on vascular calcification remain controversial. This retrospective study investigated the effects of denosumab on vascular calcification and BMD in 25 dialysis patients compared to the control group of 21 dialysis patients without denosumab over 2 yr. All patients underwent BMD assessments at 1-yr intervals, as well as evaluations of abdominal aortic vascular calcification using CT to determine changes in calcification volume and the Agatston score. Denosumab significantly increased BMD in the LS (8.5% vs 1.5%, p = .0079) compared with the control group. In contrast, the rate of increase from baseline in calcification volume and the Agatston score were significantly higher in the denosumab group compared with the controls (32.8% vs 19.3%, p = .0476; 34.6% vs 20.5%, p = .0483, respectively). Although denosumab is beneficial for bone health in patients on dialysis, its vascular effects warrant careful monitoring.
Insights
Denosumab improved bone mineral density in dialysis patients but also accelerated vascular calcification. This suggests careful monitoring of cardiovascular effects is crucial when using denosumab for bone health in CKD patients.
Area of Science:
- Nephrology
- Endocrinology
- Cardiovascular Medicine
Background:
- Chronic kidney disease (CKD) disrupts bone and mineral metabolism, increasing risks of osteoporosis and vascular calcification, major mortality factors.
- Denosumab, a RANKL inhibitor, is known to increase bone mineral density (BMD), but its impact on vascular calcification is debated.
Purpose of the Study:
- To investigate the effects of denosumab on vascular calcification and BMD in dialysis patients.
- To compare changes in calcification and BMD over two years between dialysis patients receiving denosumab and a control group.
Main Methods:
- Retrospective study of 25 dialysis patients on denosumab versus 21 controls.
- Annual BMD assessments and computed tomography (CT) scans for abdominal aortic vascular calcification volume and Agatston score.
Main Results:
- Denosumab significantly increased lumbar spine BMD (8.5% vs. 1.5%, p=0.0079).
- The denosumab group showed significantly higher increases in vascular calcification volume (32.8% vs. 19.3%, p=0.0476) and Agatston score (34.6% vs. 20.5%, p=0.0483).
Conclusions:
- Denosumab benefits bone health in dialysis patients.
- Denosumab use in dialysis patients is associated with accelerated vascular calcification, necessitating careful cardiovascular monitoring.
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