1
|
Wittoek R, Verbruggen G, Vanhaverbeke T, Colman R, Elewaut D. RANKL blockade for erosive hand osteoarthritis: a randomized placebo-controlled phase 2a trial. Nat Med 2024; 30:829-836. [PMID: 38361122 PMCID: PMC10957468 DOI: 10.1038/s41591-024-02822-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 01/19/2024] [Indexed: 02/17/2024]
Abstract
Erosive hand osteoarthritis (OA) is a prevalent and disabling disease with limited treatment options. Here we present the results of a monocentric, placebo-controlled, double-blind, randomized phase 2a clinical trial with denosumab, a receptor activator of nuclear factor-κB ligand inhibitor, evaluating the effects on structure modification in erosive hand OA. Patients were randomized to 48 weeks treatment with denosumab 60 mg every 3 months (n = 51, 41 females) or placebo (n = 49, 37 females). The primary (radiographic) endpoint was the change in the total Ghent University Scoring System (GUSS) at week 24, where positive changes correspond to remodeling and negative changes to erosive progression. Secondary endpoints were the change in the GUSS at week 48 and the number of new erosive joints at week 48 by the anatomical phase scoring system. Baseline mean GUSS (standard deviation) of target joints was 155.9 (69.3) in the denosumab group and 158.7 (46.8) in the placebo group. The primary endpoint was met with an estimated difference between groups of 8.9 (95% confidence interval (CI) 1.0 to 16.9; P = 0.024) at week 24. This effect was confirmed at week 48 (baseline adjusted GUSS (standard error of the mean) denosumab and placebo were 163.5 (2.9) and 149.2 (3.9), respectively; with an estimated difference between groups of 14.3 (95% CI 4.6 to 24.0; P = 0.003)). At patient level, more new erosive joints were developed in the placebo group compared with denosumab at week 48 (odds ratio 0.24 (95% CI 0.08 to 0.72); P = 0.009). More adverse events occurred in the placebo group (125 events in 44 patients (90%)) compared with the denosumab group (97 events in 41 patients (80%)). These results demonstrate that denosumab has structure modifying effects in erosive hand OA by inducing remodeling and preventing new erosive joints. EU Clinical Trials Register identifier 2015-003223-53 .
Collapse
Affiliation(s)
- Ruth Wittoek
- Department of Rheumatology, Ghent University Hospital, Ghent University, Ghent, Belgium.
| | - Gust Verbruggen
- Department of Rheumatology, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - Tine Vanhaverbeke
- Department of Rheumatology, Ghent University Hospital, Ghent University, Ghent, Belgium
- VIB Center for Inflammation Research, Ghent University, Ghent, Belgium
| | - Roos Colman
- Biostatistics Unit, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Dirk Elewaut
- Department of Rheumatology, Ghent University Hospital, Ghent University, Ghent, Belgium
- VIB Center for Inflammation Research, Ghent University, Ghent, Belgium
| |
Collapse
|
2
|
Pereira-Silva M, Hadad H, de Jesus LK, de Freitas Santana Oliveira ME, de Almeida JM, Nímia HH, Magro Filho O, Okamoto R, Macedo SB, Palmieri Junior CF, Souza FÁ. Ozone therapy effect in medication-related osteonecrosis of the jaw as prevention or treatment: microtomographic, confocal laser microscopy and histomorphometric analysis. Clin Oral Investig 2024; 28:151. [PMID: 38360985 DOI: 10.1007/s00784-024-05547-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 02/07/2024] [Indexed: 02/17/2024]
Abstract
OBJECTIVE This study aimed to evaluate the efficacy of ozone therapy in the preoperative (prevention) and/or postoperative (treatment) of MRONJ. MATERIAL AND METHODS Forty male Wistar rats were caudally treated with zoledronic acid (ZOL) and to ozone therapy before extraction (prevention, POG), after extraction (treatment, TOG), or both (prevention and treatment, TPOG), and treated with saline (SAL). The animals received intramuscular fluorochrome (calcein and alizarin), and 28 days postoperatively, they were euthanized, and the tissues were subjected to microtomographic computed tomography (microCT), LASER confocal, and histomorphometric analyses. RESULTS Micro-CT showed a higher bone volume fraction average in all groups than that in the ZOL group (P < 0.001), the ZOL group showed high porosity (P = 0.03), and trabecular separation was greater in the TOG group than in the POG group (P < 0.05). The mineral apposition rate of the POG group was high (20.46 ± 6.31) (P < 0.001), followed by the TOG group (20.32 ± 7.4). The TOG group presented the highest mean newly formed bone area (68.322 ± 25.296) compared with the ZOL group (P < 0.05), followed by the SAL group (66.039 ± 28.379) and ZOL groups (60.856 ± 28.425). CONCLUSIONS Ozone therapy modulated alveolar bone repair in animals treated with ZOL, mainly after surgery trauma, leading to bone formation as healing tissue. CLINICAL RELEVANCE Osteonecrosis has been a challenge in dentistry, and owing to the lack of a consensus regarding therapy, studies presenting new therapies are important, and ozone has been one of the therapies explored empirically.
Collapse
Affiliation(s)
- Maísa Pereira-Silva
- Department of Diagnosis and Surgery, Araçatuba Dental School, São Paulo State University (UNESP), José Bonifácio Street, 1193, Vila Mendonça, Araçatuba, São Paulo, 16015050, Brazil.
| | - Henrique Hadad
- Department of Diagnosis and Surgery, Araçatuba Dental School, São Paulo State University (UNESP), José Bonifácio Street, 1193, Vila Mendonça, Araçatuba, São Paulo, 16015050, Brazil
| | - Laís Kawamata de Jesus
- Department of Diagnosis and Surgery, Araçatuba Dental School, São Paulo State University (UNESP), José Bonifácio Street, 1193, Vila Mendonça, Araçatuba, São Paulo, 16015050, Brazil
| | - Maria Eduarda de Freitas Santana Oliveira
- Department of Diagnosis and Surgery, Araçatuba Dental School, São Paulo State University (UNESP), José Bonifácio Street, 1193, Vila Mendonça, Araçatuba, São Paulo, 16015050, Brazil
| | - Juliano Milanezi de Almeida
- Department of Diagnosis and Surgery, Araçatuba Dental School, São Paulo State University (UNESP), José Bonifácio Street, 1193, Vila Mendonça, Araçatuba, São Paulo, 16015050, Brazil
| | - Heloisa Helena Nímia
- Department of Dental Materials and Prothesis, Araçatuba Dental School, São Paulo State University (UNESP), José Bonifácio Street, Araçatuba, São Paulo, 16015050, Brazil
| | - Osvaldo Magro Filho
- Department of Diagnosis and Surgery, Araçatuba Dental School, São Paulo State University (UNESP), José Bonifácio Street, 1193, Vila Mendonça, Araçatuba, São Paulo, 16015050, Brazil
| | - Roberta Okamoto
- Department of Basic Sciences, Araçatuba Dental School, São Paulo State University (UNESP), Marechal Rondon Highway, Araçatuba, São Paulo, 16066840, Brazil
| | - Sérgio Bruzadelli Macedo
- Department of Dentistry, University of Brasília (UnB), Asa Norte, Brasília, Distrito Federal, 70297-400, Brazil
| | - Celso Fernando Palmieri Junior
- Department of Oral & Maxillofacial Surgery, Louisiana State University Health Sciences Center (LSU), Kings Highway, Shreveport, LA, 71103, USA
| | - Francisley Ávila Souza
- Department of Diagnosis and Surgery, Araçatuba Dental School, São Paulo State University (UNESP), José Bonifácio Street, 1193, Vila Mendonça, Araçatuba, São Paulo, 16015050, Brazil.
| |
Collapse
|
3
|
Kojima Y, Watanabe T, Mizuki F, Izumo N, Nishimura Y. Low-Intensity Pulsed Ultrasound Maintains Bone Mass After Withdrawal of Human Parathyroid Hormone in Ovariectomized Mice. J Ultrasound Med 2024; 43:385-395. [PMID: 37994205 DOI: 10.1002/jum.16371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 08/11/2023] [Accepted: 10/30/2023] [Indexed: 11/24/2023]
Abstract
The intermittent injection of teriparatide, a recombinant fragment of human parathyroid hormone (PTH 1-34), activates anabolic activity on bone turnover. However, the PTH administration period is limited to 2 years. Thus, sequential therapy after discontinuation of PTH is required. Low-intensity pulsed ultrasound (LIPUS) has been widely used for bone fracture healing. In this study, we examined the effects of LIPUS on bone mass after PTH withdrawal in ovariectomized (OVX) model mice. The LIPUS-non-irradiated femoral trabecular bone mineral density (BMD) in the treated after PTH withdrawal was significantly decreased. Meanwhile, the femoral BMD in the OVX + PTH-LIPUS group was remarkably higher than that of the OVX group. Additionally, mRNA expression of Runx2, Osterix, Col1a1, and ALP increased significantly following LIPUS irradiation after PTH withdrawal. These results suggest that LIPUS protected against femoral trabecular BMD loss and up-regulated the osteogenic factors following PTH withdrawal in OVX mice.
Collapse
Affiliation(s)
- Yoshitsugu Kojima
- Clinical Pharmacology Research Laboratory, Yokohama University of Pharmacy, Yokohama, Kanagawa, Japan
- Planning and Product Development Division, Nippon Sigmax Co., Ltd., Shinjuku-ku, Tokyo, Japan
| | - Takayuki Watanabe
- Clinical Pharmacology Research Laboratory, Yokohama University of Pharmacy, Yokohama, Kanagawa, Japan
- Planning and Product Development Division, Nippon Sigmax Co., Ltd., Shinjuku-ku, Tokyo, Japan
| | - Fumitaka Mizuki
- Planning and Product Development Division, Nippon Sigmax Co., Ltd., Shinjuku-ku, Tokyo, Japan
| | - Nobuo Izumo
- General Health Medical Research Center, Yokohama University of Pharmacy, Yokohama, Kanagawa, Japan
- Laboratory of Pharmacotherapy, Yokohama University of Pharmacy, Yokohama, Kanagawa, Japan
| | - Yoshihiro Nishimura
- Planning and Product Development Division, Nippon Sigmax Co., Ltd., Shinjuku-ku, Tokyo, Japan
| |
Collapse
|
4
|
Kunimoto Y, Matamura R, Ikeda H, Horiguchi H, Fujii S, Kobune M, Fukudo M, Toda T. Adherence of denosumab treatment for low bone mineral density in Japanese people living with HIV: a retrospective observational study. J Pharm Health Care Sci 2023; 9:45. [PMID: 38057906 DOI: 10.1186/s40780-023-00315-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 10/22/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND Long-term care issues, specifically metabolic bone disorders, are a concern for people living with human immunodeficiency virus (PLWH) who undergo life-long antiretroviral therapy (ART). Previous clinical trials with denosumab, an anti-RANKL antibody inhibitor, have revealed its effectiveness in increasing bone mineral density (BMD) in patients with osteoporosis. However, there are limited data on adherence and effectiveness of denosumab treatment for osteoporosis in PLWH. Hence, this study aimed to investigate the adherence and effectiveness of denosumab treatment for osteoporosis in Japanese PLWH. METHODS This study is a retrospective exploratory analysis of 29 Japanese PLWH who initiated denosumab treatment for osteoporosis, between 2013 and 2021. The study included patients who received at least one dose of denosumab every 6 months. Adherence and persistence were defined as receiving two consecutive injections of denosumab 6 months ± 4 weeks apart and 6 months + 8 weeks apart, respectively. The primary outcome measure of the study was the adherence of denosumab treatment for 24 months. The secondary outcome measures included treatment persistence and BMD. The period after January 2020 was defined as the coronavirus disease 2019 (COVID-19) pandemic period, and its impact on adherence was investigated. RESULTS The treatment adherence rates at 12 and 24 months were 89.7% and 60.7%, respectively. By contrast, the treatment persistence at 12 and 24 months was 100% and 85.7%, respectively. More patients in the group who initiated denosumab treatment after the COVID-19 pandemic reached non-adherence than in the group who initiated denosumab treatment before the pandemic. BMD at the lumbar spine and femoral neck significantly increased compared to that at baseline, with median percentage changes of 8.7% (p < 0.001) and 3.5% (p = 0.001), respectively. CONCLUSIONS The results showed that patients in the study had a high rate of non-adherence but a lower rate of non-persistence. Additionally, PLWH on ongoing ART experienced increased BMD with denosumab treatment. This study provides an opportunity to improve future strategies for denosumab treatment in the Japanese PLWH.
Collapse
Affiliation(s)
- Yusuke Kunimoto
- Department of Pharmacy, Sapporo Medical University Hospital, Sapporo, 060-8543, Japan
| | - Ryosuke Matamura
- Department of Pharmacy, Sapporo Medical University Hospital, Sapporo, 060-8543, Japan
| | - Hiroshi Ikeda
- Department of Hematology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Hiroto Horiguchi
- Department of Hematology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Satoshi Fujii
- Department of Pharmacy, Sapporo Medical University Hospital, Sapporo, 060-8543, Japan
| | - Masayoshi Kobune
- Department of Hematology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Masahide Fukudo
- Department of Pharmacy, Sapporo Medical University Hospital, Sapporo, 060-8543, Japan.
| | - Takaki Toda
- Department of Clinical Pharmacology, Faculty of Pharmaceutical Sciences, Hokkaido University of Science, Sapporo, Japan
| |
Collapse
|
5
|
Sauhta R, Makkar D, Siwach PS. The Sequential Therapy in Osteoporosis. Indian J Orthop 2023; 57:150-162. [PMID: 38107815 PMCID: PMC10721775 DOI: 10.1007/s43465-023-01067-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 11/15/2023] [Indexed: 12/19/2023]
Abstract
Background Osteoporosis management often involves a sequential treatment approach to optimize patient outcomes and minimize fracture risks. This strategy is tailored to individual patient characteristics, treatment responses, and fracture risk profiles. Methods A thorough literature review was systematically executed using prominent databases, including PubMed and EMBASE. The primary aim was to identify original articles and clinical trials evaluating the effectiveness of sequential therapy with anti-osteoporosis drugs, focusing on the period from 1995 to 2023. The analysis encompassed an in-depth examination of osteoporosis drugs, delineating their mechanisms of action, side effects, and current trends as elucidated in the literature. Results and Discussion Our study yielded noteworthy insights into the optimal sequencing of pharmacologic agents for the long-term treatment of patients necessitating multiple drugs. Notably, the achievement of optimal improvements in bone mass is observed when commencing treatment with an anabolic medication, followed by the subsequent utilization of an antiresorptive drug. This stands in contrast to initiating therapy with a bisphosphonate, which may potentially diminish outcomes in the post-anabolic intervention period. Furthermore, it has been discerned that caution should be exercised against transitioning from denosumab to PTH homologs due to the adverse effects of heightened bone turnover and sustained weakening of bone structure. Despite the absence of fracture data substantiating the implementation of integrated anabolic/antiresorptive pharmacotherapy, the incorporation of denosumab and teriparatide presents a potential avenue worthy of consideration for individuals at a heightened vulnerability to fragility fractures. Conclusions A judiciously implemented sequential treatment strategy in osteoporosis offers a flexible and tailored approach to address diverse clinical scenarios, optimizing fracture prevention and patient outcomes.
Collapse
Affiliation(s)
- Ravi Sauhta
- Department Orthopedics and Joint
Replacement, Artemis Hospitals, Gurgaon, India
| | | | | |
Collapse
|
6
|
Kumar L, Arora MK, Marwah S. Biologic Antiresorptive: Denosumab. Indian J Orthop 2023; 57:127-134. [PMID: 38107799 PMCID: PMC10721778 DOI: 10.1007/s43465-023-01064-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 11/14/2023] [Indexed: 12/19/2023]
Abstract
Background Osteoporosis is an age-related common bone disorder characterized by low bone mineral density and increased fragility fracture risk. Various Antiresorptive medications are being used to target osteoclast mediated bone resorption to prevent bone loss and reduce fracture risk. About Denosumab Denosumab is a novel biological antiresorptive drug that belongs to the class of monoclonal antibodies. It binds to and inhibits the cytokine receptor activator of nuclear factor kappa-B ligand (RANKL), which is requisite for osteoclast differentiation, function and survival. Effectiveness Denosumab has been shown to be a potent and effective therapy for osteoporosis, with clinical trial data demonstrating significant improvement in bone mineral density (BMD) and reductions in fracture risk at various skeletal sites for more than 10 years of treatment. Safety Profile Denosumab has a favourable benefit/risk profile, with low rates of complications such as infection, atypical femoral fracture and osteonecrosis of the jawbone. Challenges However, denosumab treatment requires continuous administration, as discontinuation leads to rapid bone mineral loss and increased risk of multiple vertebral fractures due to rebound of bone turnover. Therefore, modification to another anti-osteoporosis drug therapy after denosumab discontinuation is required to maintain bone health. Conclusion Denosumab is a promising biological antiresorptive therapy for osteoporosis that offers high efficacy and safety, but also poses challenges for long-term management.
Collapse
Affiliation(s)
- Lalit Kumar
- Marengo Asia Hospital, Gurugram, Haryana India
| | | | - Sunil Marwah
- Marengo Asia Hospital, Gurugram, Haryana India
- Gurugram, India
| |
Collapse
|
7
|
Liu FC, Luk KC, Chen YC. Risk comparison of osteonecrosis of the jaw in osteoporotic patients treated with bisphosphonates vs. denosumab: a multi-institutional retrospective cohort study in Taiwan. Osteoporos Int 2023; 34:1729-1737. [PMID: 37326685 PMCID: PMC10511380 DOI: 10.1007/s00198-023-06818-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Accepted: 05/30/2023] [Indexed: 06/17/2023]
Abstract
In this multi-institutional retrospective cohort study, we compared the long-term risk of osteonecrosis of the jaw following the use of denosumab vs. bisphosphonates in osteoporotic patients. After 2-year use, the likelihood of osteonecrosis of the jaw is lower with denosumab compared to bisphosphonates, and the difference increases with time. PURPOSE To compare the long-term risk of osteonecrosis of the jaw (ONJ) between osteoporotic patients treated with bisphosphonates (BPs) and denosumab. METHODS This multi-institutional retrospective cohort study included patients aged > 40 years with osteoporosis between January 2010 and December 2018. Patients who met the eligibility criteria were divided into BPs and denosumab groups by propensity score matching (PSM). The risk of ONJ of denosumab vs. BPs was estimated using a Cox proportional hazards model and was described by the cumulative incidence rate using the Kaplan-Meier method. RESULTS A total of 84,102 patients with osteoporosis were enrolled, among whom, 8962 were eligible for inclusion based on their first-line drug use (denosumab, n = 3,823; BPs, n = 5,139). Following PCM matching (1:1), the BPs and denosumab groups included 3665 patients each. The incidence density of ONJ in the denosumab and BPs matching groups was 1.47 vs. 2.49 events (per 1000 person-years), respectively. The hazard ratio of ONJ in the denosumab vs. BPs group was estimated as 0.581 (95% confidence interval: 0.33-1.04, p = 0.07). The cumulative incidence rates of ONJ in both groups were similar for the first and second years of drug use (p = 0.062), but significantly different from the third year onwards (p = 0.022). The severity of ONJ was not significantly different between the two groups. CONCLUSION In osteoporotic patients, after 2 years of use, the likelihood of ONJ being induced by denosumab is lower than that of BPs, and the difference increases with time.
Collapse
Affiliation(s)
- Fang-Chun Liu
- Department of Dentistry, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Kwing-Chi Luk
- Department of Dentistry, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Yung-Chih Chen
- Division of General Internal Medicine, Department of Internal Medicine, Chang Gung Memorial Hospital, Keelung, Taiwan.
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.
| |
Collapse
|
8
|
Abduelkarem AR, Guella A, Hamrouni AM, Hassanein MM, Nasr A, Rana O. Denosumab Use in Chronic Kidney Disease Associated Osteoporosis: A Narrative Review. Risk Manag Healthc Policy 2023; 16:1809-1813. [PMID: 37719685 PMCID: PMC10503558 DOI: 10.2147/rmhp.s426869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 09/06/2023] [Indexed: 09/19/2023] Open
Abstract
Chronic kidney disease (CKD) and hemodialysis (HD) patients have a high incidence of bone disease and increased fracture risk, making effective management of their bone health a clinical challenge. Denosumab, a human monoclonal antibody, has been investigated as a therapeutic option in this patient population. In this review, we summarize the current evidence on the efficacy and safety of denosumab in CKD and HD patients. A comprehensive search of the relevant literature was conducted, including randomized controlled trials, observational studies, and meta-analyses. The findings suggest that denosumab reduces the risk of fractures and improves bone mineral density in all stages of CKD. The results of this review support the use of denosumab as a promising option for managing bone disease in CKD and HD patients.
Collapse
Affiliation(s)
- Abduelmula R Abduelkarem
- Department of Pharmacy Practice and Pharmacotherapeutics, College of Pharmacy, University of Sharjah, Sharjah, United Arab Emirates
- Research Institute for Medical and Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
| | - Adnane Guella
- Department of Nephrology, University Hospital Sharjah, Sharjah, United Arab Emirates
| | - Amar M Hamrouni
- Department of Pharmaceutical Sciences, College of Pharmacy, Al Ain University, Al Ain, United Arab Emirates
| | - Mohammed M Hassanein
- Department of Pharmacy Practice and Pharmacotherapeutics, College of Pharmacy, University of Sharjah, Sharjah, United Arab Emirates
| | - Ahmed Nasr
- Pharmacy Department, University Hospital Sharjah, Sharjah, United Arab Emirates
| | - Owais Rana
- Department of Internal Medicine, University Hospital Sharjah, Sharjah, United Arab Emirates
| |
Collapse
|
9
|
Iseri K, Mizobuchi M, Winzenrieth R, Humbert L, Saitou T, Kato T, Nakajima Y, Wakasa M, Shishido K, Honda H. Long-Term Effect of Denosumab on Bone Disease in Patients with CKD. Clin J Am Soc Nephrol 2023; 18:1195-1203. [PMID: 37314764 PMCID: PMC10564351 DOI: 10.2215/cjn.0000000000000213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 06/06/2023] [Indexed: 06/15/2023]
Abstract
BACKGROUND The effect of long-term denosumab therapy and of denosumab discontinuation on the cortical bone of the hip regions in dialysis patients has not been studied. METHODS This retrospective study investigated the cortical and trabecular compartments and estimated strength indices of the hip region, obtained using 3D-SHAPER software, after a maximum of 5 years of denosumab therapy in 124 dialysis patients. A Wilcoxon signed-rank test was used to identify the differences in each parameter before and after denosumab initiation. Similarly, we investigated the changes in these parameters after denosumab discontinuation in 11 dialysis patients. RESULTS Integral and trabecular volumetric bone mineral densities (BMD) were significantly lower at the start of denosumab therapy than those in 1 year before denosumab initiation. After starting denosumab, areal BMD (median change +7.7% [interquartile range (IQR), +4.6 to +10.6]), cortical volumetric BMD (median change +3.4% [IQR, +1.0 to +4.7]), cortical surface BMD (median change +7.1% [IQR, +3.4 to +9.4]), and cortical thickness (median change +3.2% [IQR, +1.8 to +4.9]) showed a significantly higher trend for 3.5 years, which then stabilized at a higher value compared with baseline. A similar trend in the trabecular volumetric BMD (median change +9.8% [IQR, +3.8 to +15.7]) was observed over 2.5 years, with a higher value maintained thereafter. The whole area of the hip region improved after denosumab therapy. Similar trajectories were also found in the estimated strength indices. Conversely, at 1 year after denosumab discontinuation, these 3D parameters and estimated strength indices tended to largely worsen. The lateral aspect of the greater trochanter was the most pronounced location showing volumetric BMD loss. CONCLUSIONS The BMD of both cortical and trabecular components in the hip region was significantly higher after starting denosumab therapy. However, these measurements exhibited a trend of declining substantially after the discontinuation of denosumab.
Collapse
Affiliation(s)
- Ken Iseri
- Division of Nephrology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Masahide Mizobuchi
- Division of Nephrology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | | | | | - Tomohiro Saitou
- Division of Nephrology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Tadashi Kato
- Division of Nephrology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Yutaka Nakajima
- Internal Medicine, Sekishin-kai Kawasaki Clinic, Kawasaki, Japan
| | - Mikio Wakasa
- Internal Medicine, Sekishin-kai Kawasaki Clinic, Kawasaki, Japan
| | - Kanji Shishido
- Internal Medicine, Sekishin-kai Kawasaki Clinic, Kawasaki, Japan
| | - Hirokazu Honda
- Division of Nephrology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| |
Collapse
|
10
|
Mondo I, Hannou S, D'Amelio P. Using sequential pharmacotherapy for the treatment of osteoporosis: an update of the literature. Expert Opin Pharmacother 2023; 24:2175-2186. [PMID: 38100542 DOI: 10.1080/14656566.2023.2296543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 12/14/2023] [Indexed: 12/17/2023]
Abstract
INTRODUCTION Osteoporosis, which is characterized by compromised bone density and heightened susceptibility to fractures, is a substantial public health concern, especially among the aging population. Underdiagnosis, undertreatment, and therapy non-adherence contribute to its impact. Anabolic and dual-action agents like teriparatide, abaloparatide, and romosozumab have emerged as effective treatments, allowing rapid gains in bone mineral density (BMD) and reducing fracture risk. However, administering treatments in the correct order is paramount, with an 'anabolic first' approach gaining traction for patients at high risk of fractures. This strategy involves starting anabolic therapies, followed by antiresorptive agents as maintenance therapy. It is important to note that the effectiveness of anabolic agents differs between treatment-naive and previously treated patients: tailored treatment approaches are therefore necessary. This comprehensive strategy adheres to clinical guidelines, emphasizing individualized care, early intervention, and patient-centered management to mitigate the burden of osteoporosis and enhance patients' quality of life. AREA COVERED The aim of this review is to summarize recent evidence on the sequential treatment of osteoporosis and to provide recommendations on the best treatment strategies. EXPERT OPINION Effective treatments, such as anabolic agents, are key in high-risk patients, who require an 'anabolic first' approach. Sequential therapy, specifically tailored to a patient's history, can help to optimize prevention and management of fractures.
Collapse
Affiliation(s)
- Ilaria Mondo
- Department of Geriatrics and Geriatric Rehabilitation, Lausanne University Hospital, Lausanne, Switzerland
| | - Sophia Hannou
- Department of Geriatrics and Geriatric Rehabilitation, Lausanne University Hospital, Lausanne, Switzerland
| | - Patrizia D'Amelio
- Department of Geriatrics and Geriatric Rehabilitation, Lausanne University Hospital, Lausanne, Switzerland
| |
Collapse
|
11
|
Godoi MA, Camilli AC, Gonzales KGA, Costa VB, Papathanasiou E, Leite FRM, Guimarães-Stabili MR. JAK/STAT as a Potential Therapeutic Target for Osteolytic Diseases. Int J Mol Sci 2023; 24:10290. [PMID: 37373437 PMCID: PMC10299676 DOI: 10.3390/ijms241210290] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 06/07/2023] [Accepted: 06/09/2023] [Indexed: 06/29/2023] Open
Abstract
Several cytokines with major biological functions in inflammatory diseases exert their functions through the Janus kinase (JAK)-signal transducer and activator of transcription (STAT) signal transduction pathway. JAKs phosphorylate the cytoplasmic domain of the receptor, inducing the activation of its substrates, mainly the proteins known as STATs. STATs bind to these phosphorylated tyrosine residues and translocate from the cytoplasm to the nucleus, further regulating the transcription of several genes that regulate the inflammatory response. The JAK/STAT signaling pathway plays a critical role in the pathogenesis of inflammatory diseases. There is also increasing evidence indicating that the persistent activation of the JAK/STAT signaling pathway is related to several inflammatory bone (osteolytic) diseases. However, the specific mechanism remains to be clarified. JAK/STAT signaling pathway inhibitors have gained major scientific interest to explore their potential in the prevention of the destruction of mineralized tissues in osteolytic diseases. Here, our review highlights the importance of the JAK/STAT signaling pathway in inflammation-induced bone resorption and presents the results of clinical studies and experimental models of JAK inhibitors in osteolytic diseases.
Collapse
Affiliation(s)
- Mariely A. Godoi
- Department of Diagnosis and Surgery, School of Dentistry at Araraquara, UNESP, Araraquara 14801-385, Brazil; (M.A.G.)
| | - Angelo C. Camilli
- Department of Diagnosis and Surgery, School of Dentistry at Araraquara, UNESP, Araraquara 14801-385, Brazil; (M.A.G.)
| | - Karen G. A. Gonzales
- Department of Diagnosis and Surgery, School of Dentistry at Araraquara, UNESP, Araraquara 14801-385, Brazil; (M.A.G.)
| | - Vitória B. Costa
- Department of Diagnosis and Surgery, School of Dentistry at Araraquara, UNESP, Araraquara 14801-385, Brazil; (M.A.G.)
| | - Evangelos Papathanasiou
- Department of Periodontology, Tufts University School of Dental Medicine, Boston, MA 02111, USA;
| | - Fábio R. M. Leite
- National Dental Research Institute Singapore, National Dental Centre, Singapore 168938, Singapore;
- Oral Health Academic Clinical Programme, Duke-NUS Medical School, Singapore 169857, Singapore
| | - Morgana R. Guimarães-Stabili
- Department of Diagnosis and Surgery, School of Dentistry at Araraquara, UNESP, Araraquara 14801-385, Brazil; (M.A.G.)
| |
Collapse
|
12
|
Gronskaya S, Belaya Z, Rozhinskaya L, Mamedova E, Vorontsova M, Solodovnikov A, Golounina O, Melnichenko G. Denosumab for osteoporosis in patients with primary hyperparathyroidism and mild-to-moderate renal insufficiency. Endocrine 2023:10.1007/s12020-023-03381-z. [PMID: 37133642 DOI: 10.1007/s12020-023-03381-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 04/18/2023] [Indexed: 05/04/2023]
Abstract
PURPOSE We aimed to assess the efficacy and safety of denosumab in postmenopausal women with primary hyperparathyroidism (PHPT)-related osteoporosis and chronic kidney disease (CKD). METHODS Women over 50 years of age with PHPT or postmenopausal osteoporosis (PMO) were retrospectively recruited into this longitudinal study. These PHPT and PMO groups were further categorized into subgroups based on the presence of CKD (Glomerular filtration rate (GFR) < 60 mL/min/1.73 m2). All patients were given denosumab over 24 months due to verified osteoporosis. The primary outcomes were changes in bone mineral density (BMD) and serum calcium levels. RESULTS 145 postmenopausal women median age 69 [63;77] were recruited and assigned to one of the subgroups: PHPT patients with CKD (n = 22), PHPT patients without CKD (n = 38), PMO patients with CKD (n = 17) and PMO patients without CKD (n = 68). Denosumab treatment significantly increased BMD in patients with PHPT-related osteoporosis and CKD: median T-score L1-L4 from -2.0 to -1.35 (p < 0.001), femur neck from -2.4 to -2.1 (p = 0.012), radius 33% from -3.2 to -3 (p < 0.05)) at 24 months. Changes in BMD were similar in all four studied groups compared to baseline. A marked decline in calcium was noted in the primary study group of PHPT with CKD (median ΔCa = -0.24 mmol/L p < 0.001), compared to PHPT without CKD (median ΔCa = -0.08 mmol/L p < 0.001) and PMO with or without CKD. Denosumab treatment was well-tolerated with no serious adverse events. CONCLUSION Denosumab treatment was similarly effective at increasing BMD in patients with PHPT and PMO with and without renal insufficiency. The calcium lowering effects of denosumab were most significant in patients with PHPT and CKD. The safety of denosumab did not differ among participants with and without CKD.
Collapse
Affiliation(s)
- Sofia Gronskaya
- Endocrinology Research Centre, Department of Neuroendocrinology and Bone Disease, Moscow, Russia
| | - Zhanna Belaya
- Endocrinology Research Centre, Department of Neuroendocrinology and Bone Disease, Moscow, Russia.
| | - Liudmila Rozhinskaya
- Endocrinology Research Centre, Department of Neuroendocrinology and Bone Disease, Moscow, Russia
| | - Elizaveta Mamedova
- Endocrinology Research Centre, Department of Neuroendocrinology and Bone Disease, Moscow, Russia
| | - Maria Vorontsova
- Endocrinology Research Centre, Department of Neuroendocrinology and Bone Disease, Moscow, Russia
- Lomonosov Moscow State University, Laboratory for Molecular Endocrinology, Moscow, Russia
| | | | - Olga Golounina
- Sechenov First Moscow State Medical University, Moscow, Russia
| | - Galina Melnichenko
- Endocrinology Research Centre, Department of Neuroendocrinology and Bone Disease, Moscow, Russia
| |
Collapse
|
13
|
Kasper R, Scheurer M, Pietzka S, Sakkas A, Schramm A, Wilde F, Ebeling M. MRONJ of the Mandible—From Decortication to a Complex Jaw Reconstruction Using a CAD/CAM-Guided Bilateral Scapula Flap. Medicina (B Aires) 2023; 59:medicina59030535. [PMID: 36984535 PMCID: PMC10052135 DOI: 10.3390/medicina59030535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 02/26/2023] [Accepted: 03/03/2023] [Indexed: 03/12/2023] Open
Abstract
Medication-related osteonecrosis of the jaw (MRONJ) has been an integral part of the maxillofacial patient population for some time. The therapeutic concept ranges from conservative approaches over less extended decortications to major jaw resections, which can result in a considerable loss of quality of life. Based on three case reports, this paper presents the long-term history of patients with MRONJ of the mandible, whose disease ultimately resulted in partial or total mandibular resection and subsequent multisegmental reconstruction using a microvascular anastomosed bone flap. Furthermore, a suitable alternative for complex mandibular reconstruction is demonstrated when using a free fibula flap is not possible. The options are limited, particularly when multisegmental restoration of mandibular continuity is required. One case presents a mandible reconstruction using a CAD/CAM-guided bilateral scapular free flap (CAD/CAM = Computer-Aided Design and Manufacturing), which has not been described for this purpose before. Due to the complexity, computer-assisted surgery and patient-specific implants seem reasonable, which is why a special focus was applied to this topic.
Collapse
Affiliation(s)
- Robin Kasper
- Department of Oral and Plastic Maxillofacial Surgery, Military Hospital Ulm, Academic Hospital of the University of Ulm, 89081 Ulm, Germany
- Correspondence:
| | - Mario Scheurer
- Department of Oral and Plastic Maxillofacial Surgery, Military Hospital Ulm, Academic Hospital of the University of Ulm, 89081 Ulm, Germany
| | - Sebastian Pietzka
- Department of Oral and Plastic Maxillofacial Surgery, Military Hospital Ulm, Academic Hospital of the University of Ulm, 89081 Ulm, Germany
- Department of Oral and Maxillofacial Surgery, University Hospital Ulm, 89081 Ulm, Germany
| | - Andreas Sakkas
- Department of Oral and Plastic Maxillofacial Surgery, Military Hospital Ulm, Academic Hospital of the University of Ulm, 89081 Ulm, Germany
- Department of Oral and Maxillofacial Surgery, University Hospital Ulm, 89081 Ulm, Germany
| | - Alexander Schramm
- Department of Oral and Plastic Maxillofacial Surgery, Military Hospital Ulm, Academic Hospital of the University of Ulm, 89081 Ulm, Germany
- Department of Oral and Maxillofacial Surgery, University Hospital Ulm, 89081 Ulm, Germany
| | - Frank Wilde
- Department of Oral and Plastic Maxillofacial Surgery, Military Hospital Ulm, Academic Hospital of the University of Ulm, 89081 Ulm, Germany
- Department of Oral and Maxillofacial Surgery, University Hospital Ulm, 89081 Ulm, Germany
| | - Marcel Ebeling
- Department of Oral and Plastic Maxillofacial Surgery, Military Hospital Ulm, Academic Hospital of the University of Ulm, 89081 Ulm, Germany
| |
Collapse
|
14
|
Ayers C, Kansagara D, Lazur B, Fu R, Kwon A, Harrod C. Effectiveness and Safety of Treatments to Prevent Fractures in People With Low Bone Mass or Primary Osteoporosis: A Living Systematic Review and Network Meta-analysis for the American College of Physicians. Ann Intern Med 2023; 176:182-195. [PMID: 36592455 DOI: 10.7326/m22-0684] [Citation(s) in RCA: 26] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND The prevalence of osteoporosis is increasing in the United States. PURPOSE To evaluate low bone mass and osteoporosis treatments to prevent fractures. DATA SOURCES Ovid MEDLINE ALL, Ovid Evidence Based Medicine Reviews: Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and ClinicalTrials.gov from 2014 through February 2022. STUDY SELECTION Adults receiving eligible interventions for low bone mass or osteoporosis. Randomized controlled trials (RCTs) for fracture outcomes, and RCTs and large observational studies (n ≥1000) for harms. DATA EXTRACTION Abstracted by 1 reviewer and verified by a second. Independent, dual assessments of risk of bias and certainty of evidence (CoE). DATA SYNTHESIS We included 34 RCTs (in 100 publications) and 36 observational studies. Bisphosphonates and denosumab reduced hip, clinical and radiographic vertebral, and other clinical fractures in postmenopausal females with osteoporosis (moderate to high CoE). Bisphosphonates for 36 months or more may increase the risk for atypical femoral fractures (AFFs) and osteonecrosis of the jaw (ONJ), but the absolute risks were low. Abaloparatide and teriparatide reduced clinical and radiographic vertebral fractures but increased the risk for withdrawals due to adverse events (WAEs; moderate to high CoE). Raloxifene and bazedoxifene for 36 months or more reduced radiographic vertebral but not clinical fractures (low to moderate CoE). Abaloparatide, teriparatide, and sequential romosozumab, then alendronate, may be more effective than bisphosphonates in reducing clinical fractures for 17 to 24 months in older postmenopausal females at very high fracture risk (low to moderate CoE). Bisphosphonates may reduce clinical fractures in older females with low bone mass (low CoE) and radiographic vertebral fractures in males with osteoporosis (low to moderate CoE). LIMITATION Few studies examined participants with low bone mass, males, or Black-identifying persons, sequential therapy, or treatment beyond 3 years. CONCLUSION Bisphosphonates, denosumab, abaloparatide, teriparatide, and romosozumab, followed by alendronate, reduce clinical fractures in postmenopausal females with osteoporosis. Abaloparatide and teriparatide increased WAEs; longer duration bisphosphonate use may increase AFF and ONJ risk though these events were rare. PRIMARY FUNDING SOURCE American College of Physicians. (PROSPERO: CRD42021236220).
Collapse
Affiliation(s)
- Chelsea Ayers
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, Oregon (C.A.)
| | - Devan Kansagara
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, and Division of General Internal Medicine & Geriatrics, Department of Medicine, Oregon Health & Science University, Portland, Oregon (D.K.)
| | - Brittany Lazur
- Center for Evidence-based Policy, Oregon Health & Science University, Portland, Oregon (B.L.)
| | - Rongwei Fu
- Oregon Health & Science University-Portland State University School of Public Health, Portland, Oregon (R.F.)
| | - Amy Kwon
- Division of General Internal Medicine & Geriatrics, Department of Medicine, Oregon Health & Science University, Portland, Oregon (A.K.)
| | - Curtis Harrod
- Division of General Internal Medicine & Geriatrics, Department of Medicine, and Center for Evidence-based Policy, Oregon Health & Science University, Portland, Oregon (C.H.)
| |
Collapse
|
15
|
Ilona Nurmi-Lüthje, Peter Lüthje. Lessons learned from long-term side effects after zoledronic acid infusion following denosumab treatment: a case report and review of the literature. J Med Case Rep 2022; 16:473. [PMID: 36522673 DOI: 10.1186/s13256-022-03695-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 11/26/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Zoledronic acid is an intravenous, highly potent aminobisphosphonate for use in patients with primary or secondary osteoporosis. Zoledronic acid-induced prolonged side-effects are well known and quite common. However, severe side-effects can be a threat to life. We report a case of severe side-effects induced by zoledronic acid infusion, and its positive effect on long-term back pain. CASE PRESENTATION In 2012, a 62-year-old white native Finnish woman was operated on for an estrogen and progesterone receptor-positive breast cancer. After radiotherapy, an aromatase inhibitor (letrozole) was started. Nine months after the operation, the patient suffered a low-energy compression fracture of Th XII. She received denosumab to prevent fragility fractures and to improve bone mineral density. Letrozole was discontinued after 5.5 years, and the last denosumab injection was given after 7 years. Six months later, at the age of 71 years, the patient received a single intravenous zoledronic acid infusion. Suddenly, at 10 hours from the infusion, she complained of severe trismus, muscle twitching, spasms, and tingling, matching hypocalcemia and several other symptoms. Her serum 25-hydroxyvitamin D concentration was high (163 nmol/L), the concentration of serum calcium and calcium-ion was normal (2.32 mmol/L and 1.23 mmol/L, respectively). However, the neutrophil to lymphocyte ratio (NLR) was low (1.6). A complete recovery took 2 months. Zoledronic acid infusion also had a positive effect: for many years, the patient had suffered low back pain and strain, which came to an end after this single infusion. CONCLUSION It is important that the potential patients receive sufficient information about the possibility of side-effects following the administration of intravenous zoledronic acid. To ensure that a zoledronic acid infusion is given as safely as possible, the safety information should include that the patient should not be left without monitoring for a minimum 24 hours after the infusion. Being alone and experiencing serious side-effects may lead to acute cardiac problems. Furthermore, the chronic low back pain and strain that our patient suffered for many years has clearly reduced for 16 months after infusion, so far. We conclude that this is a positive effect of zoledronic acid.
Collapse
|
16
|
Chandran M. The why and how of sequential and combination therapy in osteoporosis. A review of the current evidence. Archives of Endocrinology and Metabolism 2022; 66:724-738. [PMID: 36382762 PMCID: PMC10118820 DOI: 10.20945/2359-3997000000564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
It is now well recognized that over the lifetime of a patient with osteoporosis, more than one medication will be needed to treat the disease and to decrease fracture risk. Though current gaps in osteoporosis therapy can be potentially mitigated with sequential and combination regimens, how to move seamlessly amongst the multiple treatments currently available for osteoporosis for sustained efficacy is still unclear. Data from recent studies show that an anabolic agent such as teriparatide or romosozumab followed by an antiresorptive affords maximal gain in BMD and possibly better and earlier fracture risk reduction compared to a regimen which follows the opposite sequence. Sequentially moving to a bisphosphonate such as alendronate from an anabolic agent such as abaloparatide has also been shown to preserve the fracture reduction benefits seen with the latter. This sequence of an anabolic agent followed by an antiresorptive should especially be considered in the high-risk patient with imminent fracture risk to rapidly reduce the risk of subsequent fractures. The data surrounding optimum timing of initiation of bisphosphonate therapy following denosumab discontinuation is still unclear. Though data suggests that combining a bisphosphonate with teriparatide does not provide substantial BMD gains compared to monotherapy, the concomitant administration of denosumab with teriparatide has been shown to significantly increase areal BMD as well as to increase volumetric BMD and estimated bone strength. This narrative review explores the available evidence regarding the various sequential and combination therapy approaches and the potential role they could play in better managing osteoporosis.
Collapse
|
17
|
Esteban-Lopez M, Wilson KJ, Myhr C, Kaftanovskaya EM, Henderson MJ, Southall NT, Xu X, Wang A, Hu X, Barnaeva E, Ye W, George ER, Sherrill JT, Ferrer M, Morello R, Agoulnik IU, Marugan JJ, Agoulnik AI. Discovery of small molecule agonists of the Relaxin Family Peptide Receptor 2. Commun Biol 2022; 5:1183. [PMCID: PMC9636434 DOI: 10.1038/s42003-022-04143-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 10/20/2022] [Indexed: 11/06/2022] Open
Abstract
The relaxin/insulin-like family peptide receptor 2 (RXFP2) belongs to the family of class A G-protein coupled receptors (GPCRs) and it is the only known target for the insulin-like factor 3 peptide (INSL3). The importance of this ligand-receptor pair in the development of the gubernacular ligament during the transabdominal phase of testicular descent is well established. More recently, RXFP2 has been implicated in maintaining healthy bone formation. In this report, we describe the discovery of a small molecule series of RXFP2 agonists. These compounds are highly potent, efficacious, and selective RXFP2 allosteric agonists that induce gubernacular invagination in mouse embryos, increase mineralization activity in human osteoblasts in vitro, and improve bone trabecular parameters in adult mice. The described RXFP2 agonists are orally bioavailable and display favorable pharmacokinetic properties, which allow for future evaluation of the therapeutic benefits of modulating RXFP2 activation in disease models. Specific small molecule RXFP2 agonists with favorable pharmacokinetic properties induce gubernacular invagination in mouse embryos, increase mineralization activity in human osteoblasts in vitro, and improve bone trabecular parameters in adult mice.
Collapse
Affiliation(s)
- Maria Esteban-Lopez
- grid.65456.340000 0001 2110 1845Department of Human and Molecular Genetics, Herbert Wertheim College of Medicine, Florida International University, Miami, FL USA
| | - Kenneth J. Wilson
- grid.94365.3d0000 0001 2297 5165Early Translation Branch, National Center for Advancing Translational Sciences, National Institutes of Health, Bethesda, MD USA
| | - Courtney Myhr
- grid.65456.340000 0001 2110 1845Department of Human and Molecular Genetics, Herbert Wertheim College of Medicine, Florida International University, Miami, FL USA
| | - Elena M. Kaftanovskaya
- grid.65456.340000 0001 2110 1845Department of Human and Molecular Genetics, Herbert Wertheim College of Medicine, Florida International University, Miami, FL USA
| | - Mark J. Henderson
- grid.94365.3d0000 0001 2297 5165Early Translation Branch, National Center for Advancing Translational Sciences, National Institutes of Health, Bethesda, MD USA
| | - Noel T. Southall
- grid.94365.3d0000 0001 2297 5165Early Translation Branch, National Center for Advancing Translational Sciences, National Institutes of Health, Bethesda, MD USA
| | - Xin Xu
- grid.94365.3d0000 0001 2297 5165Early Translation Branch, National Center for Advancing Translational Sciences, National Institutes of Health, Bethesda, MD USA
| | - Amy Wang
- grid.94365.3d0000 0001 2297 5165Early Translation Branch, National Center for Advancing Translational Sciences, National Institutes of Health, Bethesda, MD USA
| | - Xin Hu
- grid.94365.3d0000 0001 2297 5165Early Translation Branch, National Center for Advancing Translational Sciences, National Institutes of Health, Bethesda, MD USA
| | - Elena Barnaeva
- grid.94365.3d0000 0001 2297 5165Early Translation Branch, National Center for Advancing Translational Sciences, National Institutes of Health, Bethesda, MD USA
| | - Wenjuan Ye
- grid.94365.3d0000 0001 2297 5165Early Translation Branch, National Center for Advancing Translational Sciences, National Institutes of Health, Bethesda, MD USA
| | - Emmett R. George
- grid.94365.3d0000 0001 2297 5165Early Translation Branch, National Center for Advancing Translational Sciences, National Institutes of Health, Bethesda, MD USA
| | - John T. Sherrill
- grid.241054.60000 0004 4687 1637Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, AR USA
| | - Marc Ferrer
- grid.94365.3d0000 0001 2297 5165Early Translation Branch, National Center for Advancing Translational Sciences, National Institutes of Health, Bethesda, MD USA
| | - Roy Morello
- grid.241054.60000 0004 4687 1637Department of Physiology & Cell Biology, University of Arkansas for Medical Sciences, Little Rock, AR USA
| | - Irina U. Agoulnik
- grid.65456.340000 0001 2110 1845Department of Human and Molecular Genetics, Herbert Wertheim College of Medicine, Florida International University, Miami, FL USA ,grid.65456.340000 0001 2110 1845Biomolecular Sciences Institute, Florida International University, Miami, FL USA
| | - Juan J. Marugan
- grid.94365.3d0000 0001 2297 5165Early Translation Branch, National Center for Advancing Translational Sciences, National Institutes of Health, Bethesda, MD USA
| | - Alexander I. Agoulnik
- grid.65456.340000 0001 2110 1845Department of Human and Molecular Genetics, Herbert Wertheim College of Medicine, Florida International University, Miami, FL USA ,grid.65456.340000 0001 2110 1845Biomolecular Sciences Institute, Florida International University, Miami, FL USA
| |
Collapse
|
18
|
Kumar S, Chang R, Reyes M, Diamond T. Atypical femoral fracture in a bisphosphonate-naïve patient on denosumab for osteoporosis. Arch Osteoporos 2022; 17:131. [PMID: 36180610 DOI: 10.1007/s11657-022-01166-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 05/23/2022] [Indexed: 02/03/2023]
Abstract
A post-menopausal Caucasian woman sustained an atypical femoral fracture (AFF) after 5-years continuous denosumab for osteoporosis without prior bisphosphonate exposure. This is only the fifth case reported of AFF in a bisphosphonate-naïve patient receiving denosumab for osteoporosis. Although rare, physicians should consider AFF in patients taking denosumab even without prior bisphosphonate exposure. INTRODUCTION Denosumab has demonstrated overwhelmingly favourable skeletal benefit/risk profile in managing post-menopausal osteoporosis with up to 10-year exposure in the extension of the pivotal FREEDOM randomised placebo-controlled trial. Four previous cases of atypical femoral fracture have been reported in bisphosphonate-naïve patients receiving denosumab for osteoporosis. METHODS We present an 85-year-old Caucasian post-menopausal woman without prior fragility fracture who sustained unilateral atypical femoral fracture after 5-years continuous subcutaneous denosumab for osteoporosis. She had no prior bisphosphonate or glucocorticoid exposure and had known chronic kidney disease. RESULTS X-ray scan demonstrated complete, non-comminuted left proximal femoral shaft fracture meeting radiographic criteria for an atypical femoral fracture. Computed tomography (CT) scan lower limbs revealed unusual side-by-side appearance of proximal and distal fragments of left proximal femur. DXA BMD was artefactually elevated at lumbar spine (1.504 g/cm2, T-score + 2.5) and low-normal at right femoral neck (0.856 g/cm2, T-score -1.0). Serum biochemistry showed renal impairment at baseline (eGFR 30 mL/min/1.73m2). Low-normal serum C telopeptide of type 1 collagen (CTX) (230 ng/L) indicated therapeutic suppression of bone resorption. CONCLUSION The patient underwent intramedullary nailing of the femur and denosumab was ceased. This is only the fifth case reported of atypical femoral fracture in a bisphosphonate-naïve patient receiving denosumab for osteoporosis. Although rare, physicians should maintain a high index of suspicion for atypical femoral fracture in a patient taking denosumab even without prior bisphosphonate exposure.
Collapse
|
19
|
LeBoff MS, Greenspan SL, Insogna KL, Lewiecki EM, Saag KG, Singer AJ, Siris ES. The clinician's guide to prevention and treatment of osteoporosis. Osteoporos Int 2022; 33:2049-2102. [PMID: 35478046 PMCID: PMC9546973 DOI: 10.1007/s00198-021-05900-y] [Citation(s) in RCA: 189] [Impact Index Per Article: 94.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 02/19/2021] [Indexed: 12/16/2022]
Abstract
Osteoporosis is the most common metabolic bone disease in the USA and the world. It is a subclinical condition until complicated by fracture(s). These fractures place an enormous medical and personal burden on individuals who suffer from them and take a significant economic toll. Any new fracture in an adult aged 50 years or older signifies imminent elevated risk for subsequent fractures, particularly in the year following the initial fracture. What a patient perceives as an unfortunate accident may be seen as a sentinel event indicative of bone fragility and increased future fracture risk even when the result of considerable trauma. Clinical or subclinical vertebral fractures, the most common type of osteoporotic fractures, are associated with a 5-fold increased risk for additional vertebral fractures and a 2- to 3-fold increased risk for fractures at other sites. Untreated osteoporosis can lead to a vicious cycle of recurrent fracture(s), often resulting in disability and premature death. In appropriate patients, treatment with effective antifracture medication prevents fractures and improves outcomes. Primary care providers and medical specialists are critical gatekeepers who can identify fractures and initiate proven osteoporosis interventions. Osteoporosis detection, diagnosis, and treatment should be routine practice in all adult healthcare settings. The Bone Health and Osteoporosis Foundation (BHOF) - formerly the National Osteoporosis Foundation - first published the Clinician's Guide in 1999 to provide accurate information on osteoporosis prevention and treatment. Since that time, significant improvements have been made in diagnostic technologies and treatments for osteoporosis. Despite these advances, a disturbing gap persists in patient care. At-risk patients are often not screened to establish fracture probability and not educated about fracture prevention. Most concerning, the majority of highest risk women and men who have a fracture(s) are not diagnosed and do not receive effective, FDA-approved therapies. Even those prescribed appropriate therapy are unlikely to take the medication as prescribed. The Clinician's Guide offers concise recommendations regarding prevention, risk assessment, diagnosis, and treatment of osteoporosis in postmenopausal women and men aged 50 years and older. It includes indications for bone densitometry as well as fracture risk thresholds for pharmacologic intervention. Current medications build bone and/or decrease bone breakdown and dramatically reduce incident fractures. All antifracture therapeutics treat but do not cure the disease. Skeletal deterioration resumes sooner or later when a medication is discontinued-sooner for nonbisphosphonates and later for bisphosphonates. Even if normal BMD is achieved, osteoporosis and elevated risk for fracture are still present. The diagnosis of osteoporosis persists even if subsequent DXA T-scores are above - 2.5. Ongoing monitoring and strategic interventions will be necessary if fractures are to be avoided. In addition to pharmacotherapy, adequate intake of calcium and vitamin D, avoidance of smoking and excessive alcohol intake, weight-bearing and resistance-training exercise, and fall prevention are included in the fracture prevention armamentarium. Where possible, recommendations in this guide are based on evidence from RCTs; however, relevant published data and guidance from expert clinical experience provides the basis for recommendations in those areas where RCT evidence is currently deficient or not applicable to the many osteoporosis patients not considered for RCT participation due to age and morbidity.
Collapse
Affiliation(s)
- M. S. LeBoff
- grid.38142.3c000000041936754XBrigham and Women’s Hospital, Harvard Medical School, 221 Longwood Ave, Boston, MA 02115 USA
| | - S. L. Greenspan
- grid.412689.00000 0001 0650 7433University of Pittsburgh Medical Center, 1110 Kaufmann Building, 3471 Fifth Ave, Pittsburgh, PA 15213 USA
| | - K. L. Insogna
- grid.47100.320000000419368710Yale School of Medicine, 333 Cedar St, New Haven, CT 06520 USA
| | - E. M. Lewiecki
- grid.266832.b0000 0001 2188 8502University of New Mexico Health Sciences Center, 300 Oak St NE, Albuquerque, NM 87106 USA
| | - K. G. Saag
- grid.265892.20000000106344187University of Alabama at Birmingham, 1720 2nd Avenue South, FOT 820, Birmingham, AL 35294 USA
| | - A. J. Singer
- grid.411663.70000 0000 8937 0972MedStar Georgetown University Hospital and Georgetown University Medical Center, 3800 Reservoir Road NW, 3rd Floor, Washington, DC 20007 USA
| | - E. S. Siris
- grid.21729.3f0000000419368729Columbia University Irving Medical Center, 180 Fort Washington Ave, Suite 9-903, New York, NY 10032 USA
| |
Collapse
|
20
|
Yazan CD, Bugdayci O, Ilgin C, Yavuz DG. Effect of denosumab treatment on bone mineral density and bone turnover markers in osteoporotic patients: real-life experience 2-year follow-up. Arch Osteoporos 2022; 17:125. [PMID: 36114901 DOI: 10.1007/s11657-022-01145-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 07/11/2022] [Indexed: 02/03/2023]
Abstract
Denosumab leads to improvements in BMD levels and is a well-tolerated agent according to results of randomized controlled studies but results in real-life setting are important to evaluate drug adherence and real-life efficiency. In this study, we present the results of 305 patients that were treated with denosumab in our clinic. INTRODUCTION The long-term efficacy of anti-osteoclastic drugs in treatment of osteoporosis is well known. Denosumab, a novel human monoclonal antibody, is an anti-osteoclastic agent that has been shown to lead to reductions in vertebral, nonvertebral, and hip fracture risk in randomized and observational studies. Real-life data of this agent is increasing. In this study, we presented our real-life data about the 2-year follow-up of patients under denosumab treatment. METHODS Osteoporotic patients who were treated with at least one denosumab injection between 2014 and 2020 years were included. Clinical and demographic data, bone turnover markers, and radiological reports (bone mineral densitometry (BMD), vertebral x-ray) were obtained from patient files retrospectively. RESULTS A total of 305 patients (f/m: 275/30, 68.1 ± 11.05 years) were included. The median injection number was 4 (1-10). Two hundred seventy-three patients (89.8%) were persistent on treatment at the 12th month; 175 patients (57.3%) were persistent at 24th month. Sixty-eight patients (22%) were not using denosumab anymore, 55 of the patients were not continuing by doctor desicion and 13 were not continuing due to patient-related causes. Median BMD levels significantly increased from 0.809 (0.2-1.601, IQR: 0.136) to 0.861 (0.517-1.607, IQR: 0.14) in L1-L4 and from 0.702 (0.349-0.997, IQR: 0.125) to 0.745 (0.508-1.008, IQR: 0.137) in femur area at the 24th month of treatment. An improvement of 8.04% in L1-L4 BMD and 4.5% in femur neck BMD levels at the 24th month of treatment was observed. There was a significant decrease in bone turnover markers at the 24th month of treatment. CONCLUSION In our group of patients under denosumab treatment, 53% of persistence was found at 24 months and associated with improvement in BMD levels without any significant side effects except one case with urticarial reaction. Denosumab leads to improvements in BMD levels and is a well-tolerated agent in a real-life setting comparable to results of randomized controlled studies in patients with different comorbidities.
Collapse
Affiliation(s)
- Ceyda Dincer Yazan
- Department of Endocrinology and Metabolism, Marmara University School of Medicine, Istanbul, Turkey.
| | - Onur Bugdayci
- Department of Radiology, Marmara University School of Medicine, Istanbul, Turkey
| | - Can Ilgin
- Department of Public Health, Marmara University School of Medicine, Istanbul, Turkey
| | - Dilek Gogas Yavuz
- Department of Endocrinology and Metabolism, Marmara University School of Medicine, Istanbul, Turkey
| |
Collapse
|
21
|
Kaysin MY, Aktaş İ, Özkan FÜ, Zeytin İBK. Changes in dual energy X-ray absorptiometry parameters in postmenopausal women with osteoporosis who received at least 12 months of denosumab treatment. J Surg Med 2022; 6:778-782. [DOI: 10.28982/josam.1020236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background/Aim: Denosumab is a human monoclonal antibody that binds to the receptor-activated nuclear factor kappa beta ligand (RANKL). Densosumab leads to a reduction in bone resorption by inhibiting RANKL and has been approved for treating postmenopausal osteoporosis (OP). The present study investigated real life data by evaluating the demographic data of postmenopausal patients with OP who received denosumab treatment and the changes in dual energy x-ray absorptiometry (DEXA) parameters before and after denosumab treatment.
Methods: This retrospective cohort study included 49 postmenopausal female patients followed in our OP outpatient clinic who were treated with 60 mg subcutaneous denosumab every six months for at least 12 months. The study retrospectively analyzed and recorded patient age, body mass index, age of menopause, fracture history, antiresorptive and/or anabolic drug treatment history, and pre- and post-denosumab T-scores in addition to L1–4, femoral neck, and total hip bone mineral densities (BMDs) on DEXA scans. The changes that occurred before and after the treatment in addition to those that occurred after the treatment based on whether previous anabolic or antiresorptive agents had been used were statistically compared.
Results: The L1–4 and total hip T-scores and L1–4 and total hip BMD values measured prior to denosumab treatment showed a statistically significant increase after denosumab treatment (P < 0.001, P = 0.002, P = 0.028, and P = 0.002, respectively). No statistically significant changes in the femoral neck T-score and BMD after denosumab treatment compared to that before denosumab use (P = 0.056 and P = 0.138, respectively) were found. Furthermore, no statistically significant difference between the pre- and post-denosumab DEXA parameters in the patients who used antiresorptive agents and those who did not (P > 0.05) was found. Additionally, pre- and post-denosumab parameters were not statistically significantly different between those who received and did not receive anabolic therapy before denosumab (P > 0.05).
Conclusion: Denosumab treatment for postmenopausal OP leads to a significant increase in lumbar and total hip T-scores and BMDs.
Collapse
|
22
|
O'Kelly J, Bartsch R, Kossack N, Borchert J, Pignot M, Hadji P. Real-world effectiveness of osteoporosis treatments in Germany. Arch Osteoporos 2022; 17:119. [PMID: 36044096 DOI: 10.1007/s11657-022-01156-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 08/09/2022] [Indexed: 02/03/2023]
Abstract
This observational study assessed the impact on the fracture incidence of osteoporosis medications in postmenopausal women in Germany. Continued treatment with osteoporosis medications was associated with reductions of fracture rates in a real-world setting. PURPOSE The efficacy of osteoporosis medications has been demonstrated in clinical trials, but a lack of evidence exists of their real-world effectiveness. This real-world study assessed the treatment patterns and impact on the fracture incidence of osteoporosis medications in postmenopausal women in Germany. METHODS This cohort study used data from the WIG2 benchmark database, a German anonymised healthcare claims database. All women ≥ 50 years of age with ≥ 1 prescription for osteoporosis medication between 1 January 2013 and 31 December 2017 were included. The primary outcome was treatment effectiveness, evaluated as the change in fracture incidence after initiating treatment. Fracture types included all fractures, clinical vertebral, hip and wrist/forearm. Fracture incidence was assessed during the early-treatment period (0-3 months) and the on-treatment period (4-12, 13-24, 25-36 and 37-48 months). RESULTS Baseline covariates and treatment patterns were determined for 41,861 patients. The median duration of therapy was longer with denosumab (587 days) than with intravenous ibandronate (451 days), intravenous zoledronate (389 days) or oral bisphosphonates (258 days). The baseline incidence rate of all fractures was higher in patients receiving denosumab than in those receiving other treatments (87.6, 78.2, 56.6 and 66.0 per 1000 person-years for denosumab, oral bisphosphonates, intravenous ibandronate and intravenous zoledronate, respectively). Rates of all fractures declined with continued denosumab (by 38%, 50%, 56% and 67% at 12, 24, 36 and 48 months, respectively) and oral bisphosphonates (by 39%, 44%, 49% and 42%, respectively) treatment. CONCLUSION Continued treatment with osteoporosis medications was associated with reductions of fracture rates in a real-world setting.
Collapse
|
23
|
Georgiadis GF, Chatzopoulos STD, Maniatis KA, Begkas DG. A Rare Case of an Intertrochanteric Hip Fracture Combined with an Ipsilateral Incomplete Atypical Femoral Fracture Treated with a Long Gamma Intramedullary Nail. J Orthop Case Rep 2022; 12:65-69. [PMID: 36687480 PMCID: PMC9831216 DOI: 10.13107/jocr.2022.v12.i08.2968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 04/20/2022] [Indexed: 11/06/2022] Open
Abstract
Introduction Osteoporotic hip fractures can occur at the femoral neck and intertrochanteric area, with the peritrochanteric fracture being responsible for half of these fractures in the geriatric population. Atypical femoral fractures have been associated in the literature with long-term use of bisphosphonates or denosumab. However, few cases with the characteristics of these fractures have been reported in the past in patients not receiving antiresorptive drugs. To date, no combination of an intertrochanteric fracture with an impending incomplete atypical fracture of the ipsilateral femoral diaphysis has been previously reported in the literature. Case Report We present a rare case of a 97-year-old female patient with an intertrochanteric femoral fracture, with a preexisting focal cortical thickening along the lateral aspect of the ipsilateral proximal femoral diaphysis which is a warning sing for an incomplete atypical femoral fracture. A long gamma nail was used to fix the intertrochanteric fracture and simultaneously to stabilize and protect the area of the atypical femoral fracture. Conclusion Any patient with a peritrochanteric hip fracture who was under long-term treatment with antiresorptive agents against osteoporosis, or has other risk factors predisposing to atypical femoral fracture, should undergo a thorough radiological examination of the ipsilateral femur, to exclude the possibility of simultaneous presence of both of the above pathologies. In any such case, the use of a long hip cephalomedullary nail seems to be the best treatment option, because it can treat both fractures at the same time.
Collapse
Affiliation(s)
- Georgios F Georgiadis
- Department of Orthopaedics and Osteoporosis, Asclepieion Voulas General Hospital, Athens, Greece,Address of Correspondence: Dr. Georgios F Georgiadis, Department of Orthopaedics and Osteoporosis, Asclepieion Voulas General Hospital, Voula, 16673, Athens, Greece. E-mail:
| | | | - Konstantinos A Maniatis
- Department of Orthopaedics and Osteoporosis, Asclepieion Voulas General Hospital, Athens, Greece
| | - Dimitrios G Begkas
- Department of Orthopaedics and Osteoporosis, Asclepieion Voulas General Hospital, Athens, Greece
| |
Collapse
|
24
|
Martínez-Reina J, Calvo-Gallego JL, Martin M, Pivonka P. Assessment of Strategies for Safe Drug Discontinuation and Transition of Denosumab Treatment in PMO—Insights From a Mechanistic PK/PD Model of Bone Turnover. Front Bioeng Biotechnol 2022; 10:886579. [PMID: 35966026 PMCID: PMC9367195 DOI: 10.3389/fbioe.2022.886579] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 04/25/2022] [Indexed: 11/29/2022] Open
Abstract
Denosumab (Dmab) treatment against postmenopausal osteoporosis (PMO) has proven very efficient in increasing bone mineral density (BMD) and reducing the risk of bone fractures. However, concerns have been recently raised regarding safety when drug treatment is discontinued. Mechanistic pharmacokinetic-pharmacodynamic (PK-PD) models are the most sophisticated tools to develop patient specific drug treatments of PMO to restore bone mass. However, only a few PK-PD models have addressed the effect of Dmab drug holidays on changes in BMD. We showed that using a standard bone cell population model (BCPM) of bone remodelling it is not possible to account for the spike in osteoclast numbers observed after Dmab discontinuation. We show that inclusion of a variable osteoclast precursor pool in BCPMs is essential to predict the experimentally observed rapid rise in osteoclast numbers and the associated increases in bone resorption. This new model also showed that Dmab withdrawal leads to a rapid increase of damage in the bone matrix, which in turn decreases the local safety factor for fatigue failure. Our simulation results show that changes in BMD strongly depend on Dmab concentration in the central compartment. Consequently, bone weight (BW) might play an important factor in calculating effective Dmab doses. The currently clinically prescribed constant Dmab dose of 60 mg injected every 6 months is less effective in increasing BMD for patients with high BW (2.5% for 80 kg in contrast to 8% for 60 kg after 6 years of treatment). However, bone loss observed 24 months after Dmab withdrawal is less pronounced in patients with high BW (3.5% for 80kg and 8.5% for 60 kg). Finally, we studied how to safely discontinue Dmab treatment by exploring several transitional and combined drug treatment strategies. Our simulation results indicate that using transitional reduced Dmab doses are not effective in reducing rapid bone loss. However, we identify that use of a bisphosphonate (BP) is highly effective in avoiding rapid bone loss and increase in bone tissue damage compared to abrupt withdrawal of Dmab. Furthermore, the final values of BMD and damage were not sensitive to the time of administration of the BP.
Collapse
Affiliation(s)
- Javier Martínez-Reina
- Departmento de Ingeniería Mecánica y Fabricación, Universidad de Sevilla, Seville, Spain
- *Correspondence: Javier Martínez-Reina,
| | | | - Madge Martin
- CNRS, Univ Paris Est Creteil, Univ Gustave Eiffel, UMR 8208, MSME, Créteil, France
| | - Peter Pivonka
- School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Brisbane, QLD, Australia
| |
Collapse
|
25
|
Sun S, Xiu C, Chai L, Chen X, Zhang L, Liu Q, Chen J, Zhou H. HDAC inhibitor quisinostat prevents estrogen deficiency-induced bone loss by suppressing bone resorption and promoting bone formation in mice. Eur J Pharmacol 2022; 927:175073. [PMID: 35636521 DOI: 10.1016/j.ejphar.2022.175073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Revised: 05/25/2022] [Accepted: 05/25/2022] [Indexed: 12/28/2022]
Abstract
Postmenopausal osteoporosis (PMOP) is a metabolic skeletal disorder characterized by reduced bone mass and impaired bone microarchitecture resulting in increased bone fragility and fracture risk. PMOP is primarily caused by excessive osteoclastogenesis induced by estrogen deficiency. Quisinostat (Qst) is a potent hydroxamate-based second-generation inhibitor of histone deacetylases (HDACs) that can inhibit osteoclast differentiation in vitro, and protect mice from titanium particle-induced osteolysis in vivo. However, whether Qst has therapeutic potential against PMOP remains unclear. In the present study, we evaluated the therapeutic efficacy of Qst on PMOP, using a murine model of ovariectomy (OVX)-induced osteoporosis. We examined the body weight, femur length, and histology of major organs, and showed that Qst did not cause obvious toxicity in mice. Micro-computed tomography and histological analyses revealed that Qst treatment prevented OVX-induced trabecular bone loss both in femurs and vertebrae. Moreover, ELISA showed that Qst decreased the serum levels of the osteoclastic bone resorption marker CTX-1, whereas increased the levels of the osteoblastic bone formation marker Osteocalcin in OVX mice. Consistent with the CTX-1 results, TRAP staining showed that Qst suppressed OVX-induced osteoclastogenesis. Mechanistically, we showed that Qst suppressed RANKL-induced osteoclast differentiation in part by inhibiting p65 nuclear translocation. Collectively, our results demonstrated that Qst can ameliorate estrogen deficiency-induced osteoporosis by inhibiting bone resorption and promoting bone formation in vivo. In summary, our study provided the first preclinical evidence to support Qst as a potential therapeutic agent for PMOP prevention and treatment.
Collapse
Affiliation(s)
- Shengxuan Sun
- Department of Orthopaedics, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, 215004, China
| | - Chunmei Xiu
- Orthopedic Institute, The First Affiliated Hospital of Soochow University, Soochow University, Suzhou, Jiangsu, 215021, China
| | - Langhui Chai
- Department of Orthopaedics, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, 215004, China
| | - Xinyu Chen
- Suzhou High School of Jiangsu Province, Suzhou, Jiangsu, 215002, China
| | - Lei Zhang
- Orthopedic Institute, The First Affiliated Hospital of Soochow University, Soochow University, Suzhou, Jiangsu, 215021, China
| | - Qingbai Liu
- Department of Orthopaedics, Lianshui County People's Hospital, The Affiliated Lianshui County People's Hospital of Kangda College of Nanjing Medical University, Huai'an, Jiangsu, 223400, China.
| | - Jianquan Chen
- Orthopedic Institute, The First Affiliated Hospital of Soochow University, Soochow University, Suzhou, Jiangsu, 215021, China.
| | - Haibin Zhou
- Department of Orthopaedics, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, 215004, China.
| |
Collapse
|
26
|
Farlay D, Rizzo S, Dempster DW, Huang S, Chines A, Brown JP, Boivin G. Bone Mineral and Organic Properties in Postmenopausal Women Treated With Denosumab for Up to 10 years. J Bone Miner Res 2022; 37:856-864. [PMID: 35249242 DOI: 10.1002/jbmr.4538] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 02/11/2022] [Accepted: 02/20/2022] [Indexed: 11/10/2022]
Abstract
In postmenopausal women with osteoporosis, denosumab (DMAb) therapy through 10 years resulted in significantly higher degree of mineralization of bone, with a subsequent increase from years 2-3 to year 5 and no further difference between years 5 and 10. Our aim was to assess the variables reflecting the quality of bone mineral and organic matrix (Fourier transform infrared microspectroscopy), and the microhardness of bone (Vickers microindentation). Cross-sectional assessments were performed in blinded fashion on iliac bone biopsies from osteoporotic women (72 from FREEDOM trial, 49 from FREEDOM Extension trial), separately in cortical and cancellous compartments. After 2-3 years of DMAb, mineral/matrix ratio and microhardness of cortical bone were significantly higher compared with placebo, whereas mineral maturity, mineral crystallinity, mineral carbonation, and collagen maturity were not different in both bone compartments. Through 5 years of DMAb, mineral carbonation was significantly lower and mineral/matrix ratio, mineral maturity, and crystallinity were significantly higher versus 2-3 years and were not different between 5 and 10 years, with the exception of mineral maturity in cancellous bone. These data support a transition of mineral to more mature crystals (within physiological range) and the completeness of secondary mineralization within 5 years of DMAb treatment. Microhardness in cortical and cancellous compartments was significantly lower at 5 years of DMAb versus 2-3 years and was not different from years 5 to 10. The lower microhardness at years 5 and 10 is likely the result of maturation of the organic matrix in a persistently low state of bone remodeling over 5 and 10 years. © 2022 American Society for Bone and Mineral Research (ASBMR).
Collapse
Affiliation(s)
- Delphine Farlay
- INSERM, UMR 1033, University of Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Sébastien Rizzo
- INSERM, UMR 1033, University of Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - David W Dempster
- Department of Pathology and Cell Biology, Columbia University, New York, NY, USA.,Regional Bone Center, Helen Hayes Hospital, West Haverstraw, NY, USA
| | - Shuang Huang
- Clinical Development, Amgen Inc., Thousand Oaks, CA, USA
| | - Arkadi Chines
- Clinical Development, Amgen Inc., Thousand Oaks, CA, USA
| | - Jacques P Brown
- CHU de Quebec Research Centre, Laval University, Quebec City, Canada
| | - Georges Boivin
- INSERM, UMR 1033, University of Lyon, Université Claude Bernard Lyon 1, Lyon, France
| |
Collapse
|
27
|
Li B, Wang P, Jiao J, Wei H, Xu W, Zhou P. Roles of the RANKL-RANK Axis in Immunity-Implications for Pathogenesis and Treatment of Bone Metastasis. Front Immunol 2022; 13:824117. [PMID: 35386705 PMCID: PMC8977491 DOI: 10.3389/fimmu.2022.824117] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Accepted: 02/16/2022] [Indexed: 12/13/2022] Open
Abstract
A substantial amount patients with cancer will develop bone metastases, with 70% of metastatic prostate and breast cancer patients harboring bone metastasis. Despite advancements in systemic therapies for advanced cancer, survival remains poor for those with bone metastases. The interaction between bone cells and the immune system contributes to a better understanding of the role that the immune system plays in the bone metastasis of cancer. The immune and bone systems share various molecules, including transcription factors, signaling molecules, and membrane receptors, which can stimulate the differentiation and activation of bone-resorbing osteoclasts. The process of cancer metastasis to bone, which deregulates bone turnover and results in bone loss and skeletal-related events (SREs), is also controlled by primary cancer-related factors that modulate the intratumoral microenvironment as well as cellular immune process. The nuclear factor kappa B ligand (RANKL) and the receptor activator of nuclear factor kappa B (RANK) are key regulators of osteoclast development, bone metabolism, lymph node development, and T-cell/dendritic cell communication. RANKL is an osteoclastogenic cytokine that links the bone and the immune system. In this review, we highlight the role of RANKL and RANK in the immune microenvironment and bone metastases and review data on the role of the regulatory mechanism of immunity in bone metastases, which could be verified through clinical efficacy of RANKL inhibitors for cancer patients with bone metastases. With the discovery of the specific role of RANK signaling in osteoclastogenesis, the humanized monoclonal antibody against RANKL, such as denosumab, was available to prevent bone loss, SREs, and bone metastases, providing a unique opportunity to target RANKL/RANK as a future strategy to prevent bone metastases.
Collapse
Affiliation(s)
- Bo Li
- Department of Orthopedic Oncology, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Pengru Wang
- Department of Orthopedic Oncology, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Jian Jiao
- Department of Orthopedic Oncology, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Haifeng Wei
- Department of Orthopedic Oncology, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Wei Xu
- Department of Orthopedic Oncology, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Pingting Zhou
- Department of Radiation Oncology, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| |
Collapse
|
28
|
Wu PH, Lin MY, Huang TH, Lee TC, Lin SY, Chen CH, Kuo MC, Chiu YW, Chang JM, Hwang SJ. Kidney Function Change and All-Cause Mortality in Denosumab Users with and without Chronic Kidney Disease. J Pers Med 2022; 12:jpm12020185. [PMID: 35207673 PMCID: PMC8875658 DOI: 10.3390/jpm12020185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 12/22/2021] [Accepted: 01/24/2022] [Indexed: 12/04/2022] Open
Abstract
Denosumab is approved for osteoporosis treatment in subjects with and without chronic kidney disease (CKD). Confirmation is required for its safety, treatment adherence, renal function effect, and mortality in patients with CKD. A retrospective cohort study was conducted to compare new users of denosumab in terms of their two-year drug adherence in all participants (overall cohort) and CKD participants (CKD subcohort), which was defined as baseline estimated glomerular filtration rate (eGFR) less than 60 mL/min/1.73 m2. The eGFR was calculated using the 2021 CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration) equation. We defined high adherence (HA) users as receiving three or four doses and low adherence (LA) users as receiving one or two doses. All-cause mortality was analyzed using Kaplan–Meier curves and Cox regression models. In total, there were 1142 subjects in the overall cohort and 500 subjects in the CKD subcohort. HA users had better renal function status at baseline than LD users in the overall cohort. A decline in renal function was only observed among LD users in the overall cohort. In the CKD subcohort, no baseline renal function difference or renal function decline was demonstrated. The all-cause mortality rate of HA users was lower than LA users in both the overall cohort and CKD. A randomized control trial is warranted to target this unique population to confirm our observations.
Collapse
Affiliation(s)
- Ping-Hsun Wu
- Department of Internal Medicine, Division of Nephrology, Kaohsiung Medical University Hospital, Kaohsiung 80756, Taiwan; (P.-H.W.); (M.-Y.L.); (T.-H.H.); (M.-C.K.); (Y.-W.C.); (J.-M.C.); (S.-J.H.)
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
| | - Ming-Yen Lin
- Department of Internal Medicine, Division of Nephrology, Kaohsiung Medical University Hospital, Kaohsiung 80756, Taiwan; (P.-H.W.); (M.-Y.L.); (T.-H.H.); (M.-C.K.); (Y.-W.C.); (J.-M.C.); (S.-J.H.)
| | - Teng-Hui Huang
- Department of Internal Medicine, Division of Nephrology, Kaohsiung Medical University Hospital, Kaohsiung 80756, Taiwan; (P.-H.W.); (M.-Y.L.); (T.-H.H.); (M.-C.K.); (Y.-W.C.); (J.-M.C.); (S.-J.H.)
| | - Tien-Ching Lee
- Department of Orthopedics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 80756, Taiwan; (S.-Y.L.); (C.-H.C.)
- Orthopaedic Research Center, College of Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
- Regenerative Medicine and Cell Therapy Research Center, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
- Department of Orthopedics, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
- Department of Orthopedics, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung 80145, Taiwan
- Correspondence: ; Tel.: +886-7-3121101 (ext. 5751)
| | - Sung-Yen Lin
- Department of Orthopedics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 80756, Taiwan; (S.-Y.L.); (C.-H.C.)
- Orthopaedic Research Center, College of Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
- Regenerative Medicine and Cell Therapy Research Center, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
- Department of Orthopedics, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
| | - Chung-Hwan Chen
- Department of Orthopedics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 80756, Taiwan; (S.-Y.L.); (C.-H.C.)
- Orthopaedic Research Center, College of Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
- Regenerative Medicine and Cell Therapy Research Center, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
- Department of Orthopedics, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
- Department of Orthopedics, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung 80145, Taiwan
| | - Mei-Chuan Kuo
- Department of Internal Medicine, Division of Nephrology, Kaohsiung Medical University Hospital, Kaohsiung 80756, Taiwan; (P.-H.W.); (M.-Y.L.); (T.-H.H.); (M.-C.K.); (Y.-W.C.); (J.-M.C.); (S.-J.H.)
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
| | - Yi-Wen Chiu
- Department of Internal Medicine, Division of Nephrology, Kaohsiung Medical University Hospital, Kaohsiung 80756, Taiwan; (P.-H.W.); (M.-Y.L.); (T.-H.H.); (M.-C.K.); (Y.-W.C.); (J.-M.C.); (S.-J.H.)
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
| | - Jer-Ming Chang
- Department of Internal Medicine, Division of Nephrology, Kaohsiung Medical University Hospital, Kaohsiung 80756, Taiwan; (P.-H.W.); (M.-Y.L.); (T.-H.H.); (M.-C.K.); (Y.-W.C.); (J.-M.C.); (S.-J.H.)
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
| | - Shang-Jyh Hwang
- Department of Internal Medicine, Division of Nephrology, Kaohsiung Medical University Hospital, Kaohsiung 80756, Taiwan; (P.-H.W.); (M.-Y.L.); (T.-H.H.); (M.-C.K.); (Y.-W.C.); (J.-M.C.); (S.-J.H.)
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
| |
Collapse
|
29
|
Boschitsch E, Naegele O, Klinger A, Brix-Samoylenko H. Long-term persistence with denosumab: real-world data from the Austrian Osteoporosis Clinic (AOC). A retrospective data analysis. Osteoporos Int 2022; 33:263-272. [PMID: 34432114 DOI: 10.1007/s00198-021-06102-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 08/16/2021] [Indexed: 12/25/2022]
Abstract
UNLABELLED In short-term studies, persistence with denosumab has been higher than with other osteoporosis drugs. This study shows that persistence can be maintained in the long-term and is associated with efficacy and safety parameters. PURPOSE To assess long-term persistence with denosumab in postmenopausal women with osteoporosis. Secondary purposes were the evaluation of changes in efficacy and tolerance/safety parameters over time. METHODS Persistence was determined by number and rate of patients receiving denosumab on time in 6-month intervals (+ / - 8 weeks). The total population was stratified by internal patients (injections and monitoring at the Austrian Osteoporosis Clinic [AOC], 74%) and external patients (injections at the practitioner's office with occasional monitoring at the AOC, 26%). In internal patients, efficacy parameters including bone mineral density (BMD) and the bone marker CTX were assessed at fixed time points and tolerance/safety parameters including side effects (SEs), adverse events (AEs), and serious AEs (SAEs) evaluated. RESULTS Of 851 patients, 71% (73% internal and 64% external) were persistent at 7.5 years of follow-up. The mean rate of cumulative persistence in internal patients decreased from 94% at the time of the second dose to 73% at the time of the fifteenth dose. BMD increased and CTX decreased, overall and in pairwise comparisons (all p < .001). AEs and SAEs, but not SEs, were lower in persistent than non-persistent patients. CONCLUSIONS This is the first study showing that long-term (> 3 years) real-world persistence with denosumab could be maintained at a high level (> 70%) in most patients. Denosumab was well tolerated and associated with decreased CTX levels and increased BMD.
Collapse
Affiliation(s)
- Ewald Boschitsch
- Austrian Osteoporosis Clinic (AOC), Vienna, Austria.
- KLIMAX Menopause and Osteoporosis Clinic, Vienna, Austria.
| | - Oliver Naegele
- KLIMAX Menopause and Osteoporosis Clinic, Vienna, Austria
| | - Anita Klinger
- Austrian Osteoporosis Clinic (AOC), Vienna, Austria
- KLIMAX Menopause and Osteoporosis Clinic, Vienna, Austria
| | | |
Collapse
|
30
|
Shaul JL, Hill RS, Bouxsein ML, Burr DB, Tilton AK, Howe JG. AGN1 implant material to treat bone loss: Resorbable implant forms normal bone with and without alendronate in a canine critical size humeral defect model. Bone 2022; 154:116246. [PMID: 34744020 DOI: 10.1016/j.bone.2021.116246] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 10/22/2021] [Accepted: 10/25/2021] [Indexed: 11/02/2022]
Abstract
BACKGROUND Fractures secondary to osteoporosis, particularly those of the hip and spine, are a major public health concern with high social and economic costs. The Local Osteo-Enhancement Procedure (LOEP) is an approach intended to strengthen skeletal areas that are at the highest risk for fracture due to osteoporosis. LOEP involves the implantation of AGN1, a triphasic, calcium-based, osteoconductive material which is then resorbed and replaced by bone. Since alendronate is the most prescribed osteoporotic treatment, the purpose of this canine study is to determine if the newly formed bone has the same properties as normal bone and whether alendronate treatment impacts AGN1 resorption and replacement with bone. METHODS Sixty skeletally mature male hounds (24-38 kg) were evenly divided between alendronate (0.2 mg/kg/day) and non-alendronate treatment groups. A critical-size core bone defect created in one proximal humerus was implanted with AGN1 while the contralateral non-operated humerus served as a paired control in each animal. Animals were sacrificed 13, 26, and 52 weeks post-operatively (10 per treatment per timepoint). The control and treatment site bone specimens from each animal were examined using radiographic, histomorphometric, and biomechanical techniques. Results between alendronate-treated and non-alendronate-treated animals were compared as groups. RESULTS AGN1 implant material was consistently resorbed and replaced by bone in all animals. At 52 weeks, only minimal residual implant material could be detected (0.9 ± 2.3% non-alendronate group; 2.2 ± 3.1% alendronate group), and new bone filled the defects in both the non-alendronate and alendronate groups. At 13 and 26 weeks, microCT revealed the newly formed bone in the defects had significantly higher trabecular bone volume and number connectivity than control bone in both groups. Mechanical testing demonstrated that the new bone had ultimate compressive strength and modulus equivalent to control bone as early as 13 weeks post-surgery which was maintained to 52 weeks in both groups. CONCLUSIONS In this canine critical-sized humeral core defect model, AGN1 was progressively replaced by normal bone as evaluated by all outcome measures. Concurrent alendronate therapy did not significantly impact AGN1 resorption or new bone formation. These results demonstrate that AGN1 can be used in conjunction with alendronate in non-osteoporotic animals. CLINICAL RELEVANCE This study suggests that the AGN1 implant material demonstrates potential for local restoration of bone in critical-size core defects, and that the material is compatible with alendronate drug therapy. Further studies will be required to determine if these results apply to other osteoporosis medications.
Collapse
Affiliation(s)
| | - Ronald S Hill
- AgNovos Healthcare, Rockville, MD, United States of America
| | - Mary L Bouxsein
- Beth Israel Deaconess Medical Center, Boston, MA, United States of America
| | - David B Burr
- Indiana University, Indianapolis, IN, United States of America
| | | | - James G Howe
- AgNovos Healthcare, Rockville, MD, United States of America; University of Vermont, Burlington, VT, United States of America
| |
Collapse
|
31
|
Abstract
Osteocytes, former osteoblasts encapsulated by mineralized bone matrix, are far from being passive and metabolically inactive bone cells. Instead, osteocytes are multifunctional and dynamic cells capable of integrating hormonal and mechanical signals and transmitting them to effector cells in bone and in distant tissues. Osteocytes are a major source of molecules that regulate bone homeostasis by integrating both mechanical cues and hormonal signals that coordinate the differentiation and function of osteoclasts and osteoblasts. Osteocyte function is altered in both rare and common bone diseases, suggesting that osteocyte dysfunction is directly involved in the pathophysiology of several disorders affecting the skeleton. Advances in osteocyte biology initiated the development of novel therapeutics interfering with osteocyte-secreted molecules. Moreover, osteocytes are targets and key distributors of biological signals mediating the beneficial effects of several bone therapeutics used in the clinic. Here we review the most recent discoveries in osteocyte biology demonstrating that osteocytes regulate bone homeostasis and bone marrow fat via paracrine signaling, influence body composition and energy metabolism via endocrine signaling, and contribute to the damaging effects of diabetes mellitus and hematologic and metastatic cancers in the skeleton.
Collapse
Affiliation(s)
- Jesus Delgado-Calle
- 1Department of Physiology and Cell Biology, University of Arkansas for Medical Sciences, Little Rock, Arkansas,2Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Teresita Bellido
- 1Department of Physiology and Cell Biology, University of Arkansas for Medical Sciences, Little Rock, Arkansas,2Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas,3Central Arkansas Veterans Healthcare System, Little Rock, Arkansas
| |
Collapse
|
32
|
Abstract
Osteoporosis (OP), a common systemic metabolic bone disease, is characterized by low bone mass, increasing bone fragility and a high risk of fracture. At present, the clinical treatment of OP mainly involves anti-bone resorption drugs and anabolic agents for bone, but their long-term use can cause serious side effects. The development of stem cell therapy and regenerative medicine has provided a new approach to the clinical treatment of various diseases, even with a hope for cure. Recently, the therapeutic advantages of the therapy have been shown for a variety of orthopedic diseases. However, these stem cell-based researches are currently limited to animal models; the uncertainty regarding the post-transplantation fate of stem cells and their safety in recipients has largely restricted the development of human clinical trials. Nevertheless, the feasibility of mesenchymal stem cells to treat osteoporotic mice has drawn a growing amount of intriguing attention from clinicians to its potential of applying the stem cell-based therapy as a new therapeutic approach to OP in the future clinic. In the current review, therefore, we explored the potential use of mesenchymal stem cells in human OP treatment.
Collapse
Affiliation(s)
- Tianning Chen
- Ningxia Medical University, Yinchuan, 750004, Ningxia Hui-Autonomous Region, China
| | - Tieyi Yang
- Department of Orthopedics, Pudong New Area Gongli Hospital, School of Clinical Medicine, Shanghai University, Shanghai, 200135, China
| | - Weiwei Zhang
- Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, China.
| | - Jin Shao
- Department of Orthopedics, Pudong New Area Gongli Hospital, School of Clinical Medicine, Shanghai University, Shanghai, 200135, China.
| |
Collapse
|
33
|
Mori Y, Izumiyama T, Mori N, Aizawa T. Interstitial Lung Disease in a Woman with Rheumatoid Arthritis Treated with Denosumab: A Case Report. Mod Rheumatol Case Rep 2021; 6:155-159. [PMID: 34791403 DOI: 10.1093/mrcr/rxab046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 09/30/2021] [Accepted: 10/21/2021] [Indexed: 11/12/2022]
Abstract
The present report describes the case of an 84-year-old female Japanese patient with rheumatoid arthritis (RA) who experienced exacerbation of interstitial lung disease (ILD) after denosumab (Dmab) treatment. The onset of RA occurred in 2008, and the patient had been treated with intravenous or subcutaneous injection of tocilizumab (TCZ) since 2009. In July 2013, she experienced a lumbar vertebral fracture and began treatment with 60-mg Dmab injection every 6 months in January 2014. The patient had a history of mild ILD and was evaluated for ILD by chest computed tomography (CT) imaging prior to the start of Dmab use. The vertebral fracture did not recur after the initiation of Dmab treatment, and her osteoporosis was successfully treated. However, she expressed a concern of exacerbations of cough and respiratory discomfort that had occurred since September 2019. The chest CT image in November 2015 showed minor ILD progression, whereas the image in September 2019 showed severe exacerbation of ILD. To treat this exacerbation, 10 mg of methylprednisolone (mPSL) and 2.5 mg of tacrolimus (TAC) were administered, and Dmab was discontinued. The patient was subsequently switched to oral bisphosphonate. The patient's respiratory discomfort and the finding of interstitial lung lesion in CT imaging improved after Dmab discontinuation. This case showed that exacerbation of ILD may occur after Dmab treatment, and physicians should consider the risks of Dmab-related ILD in patients with RA complicated by ILD.
Collapse
Affiliation(s)
- Yu Mori
- Department of Orthopedic Surgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Takuya Izumiyama
- Department of Orthopedic Surgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Naoko Mori
- Department of Diagnostic Radiology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Toshimi Aizawa
- Department of Orthopedic Surgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| |
Collapse
|
34
|
van der Burgh AC, de Keyser CE, Zillikens MC, Stricker BH. The Effects of Osteoporotic and Non-osteoporotic Medications on Fracture Risk and Bone Mineral Density. Drugs 2021; 81:1831-58. [PMID: 34724173 DOI: 10.1007/s40265-021-01625-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/11/2021] [Indexed: 12/26/2022]
Abstract
Osteoporosis is a highly prevalent bone disease affecting more than 37.5 million individuals in the European Union (EU) and the United States of America (USA). It is characterized by low bone mineral density (BMD), impaired bone quality, and loss of structural and biomechanical properties, resulting in reduced bone strength. An increase in morbidity and mortality is seen in patients with osteoporosis, caused by the approximately 3.5 million new osteoporotic fractures occurring every year in the EU. Currently, different medications are available for the treatment of osteoporosis, including anti-resorptive and osteoanabolic medications. Bisphosphonates, which belong to the anti-resorptive medications, are the standard treatment for osteoporosis based on their positive effects on bone, long-term experience, and low costs. However, not only medications used for the treatment of osteoporosis can affect bone: several other medications are suggested to have an effect on bone as well, especially on fracture risk and BMD. Knowledge about the positive and negative effects of different medications on both fracture risk and BMD is important, as it can contribute to an improvement in osteoporosis prevention and treatment in general, and, even more importantly, to the individual's health. In this review, we therefore discuss the effects of both osteoporotic and non-osteoporotic medications on fracture risk and BMD. In addition, we discuss the underlying mechanisms of action.
Collapse
|
35
|
Migliorini F, Maffulli N, Colarossi G, Eschweiler J, Tingart M, Betsch M. Effect of drugs on bone mineral density in postmenopausal osteoporosis: a Bayesian network meta-analysis. J Orthop Surg Res 2021; 16:533. [PMID: 34452621 PMCID: PMC8393477 DOI: 10.1186/s13018-021-02678-x] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 08/16/2021] [Indexed: 12/24/2022] Open
Abstract
Background Osteoporosis affects mostly postmenopausal women, leading to deterioration of the microarchitectural bone structure and low bone mass, with an increased fracture risk with associated disability, morbidity and mortality. This Bayesian network meta-analysis compared the effects of current anti-osteoporosis drugs on bone mineral density. Methods The present systematic review and network meta-analysis follows the PRISMA extension statement to report systematic reviews incorporating network meta-analyses of health care interventions. The literature search was performed in June 2021. All randomised clinical trials that have investigated the effects of two or more drug treatments on BMD for postmenopausal osteoporosis were accessed. The network comparisons were performed through the STATA Software/MP routine for Bayesian hierarchical random-effects model analysis. The inverse variance method with standardised mean difference (SMD) was used for analysis. Results Data from 64 RCTs involving 82,732 patients were retrieved. The mean follow-up was 29.7 ± 19.6 months. Denosumab resulted in a higher spine BMD (SMD −0.220; SE 3.379), followed by pamidronate (SMD −5.662; SE 2.635) and zoledronate (SMD −10.701; SE 2.871). Denosumab resulted in a higher hip BMD (SMD −0.256; SE 3.184), followed by alendronate (SMD −17.032; SE 3.191) and ibandronate (SMD −17.250; SE 2.264). Denosumab resulted in a higher femur BMD (SMD 0.097; SE 2.091), followed by alendronate (SMD −16.030; SE 1.702) and ibandronate (SMD −17.000; SE 1.679). Conclusion Denosumab results in higher spine BMD in selected women with postmenopausal osteoporosis. Denosumab had the highest influence on hip and femur BMD. Level of evidence Level I, Bayesian network meta-analysis of RCTs
Collapse
Affiliation(s)
- Filippo Migliorini
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH Aachen University Hospital, Pauwelsstraße 30, 52074, Aachen, Germany.
| | - Nicola Maffulli
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081 Baronissi, Salerno, Italy.,Queen Mary University of London, Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, 275 Bancroft Road, London, E1 4DG, England.,School of Pharmacy and Bioengineering, Keele University Faculty of Medicine, Thornburrow Drive, Stoke on Trent, England
| | - Giorgia Colarossi
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH Aachen University Hospital, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Jörg Eschweiler
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH Aachen University Hospital, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Markus Tingart
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH Aachen University Hospital, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Marcel Betsch
- Department of Orthopaedics and Trauma Surgery, University Hospital Mannheim, Medical Faculty of the University Heidelberg, Mannheim, Germany
| |
Collapse
|
36
|
Abstract
Osteoporosis is a common chronic condition that markedly increases the risk of fractures. Osteoporotic-related fractures increase morbidity and mortality and impair quality of life. Therefore, a correct approach for fracture prevention seems mandatory. Lifestyle changes should be recommended to all patients, including weight reduction if patients are obese/overweight, increasing physical activity and avoiding alcohol consumption and smoking. Additionally, calcium and vitamin D3 should be prescribed until the vitamin D deficit is resolved. Osteoporosis treatment options mainly include antiresorptives (i.e. estrogens, selective estrogen receptor modulators, bisphosphonates, denosumab) and anabolic agents (i.e. teriparatide, abaloparatide, romosozumab). Although presenting differences in efficacy and side effects, they have all been shown to increase bone mineral density (BMD) and to reduce osteoporotic-related fractures. Monotherapy with antiresorptive agents, particularly oral bisphosphonates, should be considered routinely as the first option for treatment of postmenopausal women. However, in the case of side effects, therapeutic failure or the need for long-term use, anabolic agents may be considered. In high-risk patients, anabolic agents may be considered as an initial therapeutic option. The combination of antiresorptive and anabolic agents may be useful to increase BMD compared with monotherapy, but more information is warranted to determine the effects on fracture risk.
Collapse
Affiliation(s)
- S Palacios
- Director of Palacios Institute of Women's Health, Madrid, Spain
| |
Collapse
|
37
|
Schanda JE, Huber S, Behanova M, Haschka J, Kraus DA, Meier P, Bahrami A, Zandieh S, Muschitz C, Resch H, Mähr M, Rötzer K, Uyanik G, Zwerina J, Kocijan R. Analysis of bone architecture using fractal-based TX-Analyzer™ in adult patients with osteogenesis imperfecta. Bone 2021; 147:115915. [PMID: 33722771 DOI: 10.1016/j.bone.2021.115915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 03/06/2021] [Accepted: 03/10/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Osteogenesis imperfecta (OI) is a rare genetic disorder characterized by impaired bone quality and quantity. Established imaging techniques have limited reliability in OI. The TX-Analyzer™ is a new, fractal-based software allowing a non-invasive assessment of bone structure based on conventional radiographs. We explored whether the TX-Analyzer™ can discriminate OI patients and healthy controls. Furthermore, we investigated the correlation between TX-Analyzer™ parameters and (i) bone mineral density (BMD) by Dual Energy X-ray Absorptiometry (DXA), (ii) trabecular bone score (TBS), and (iii) bone microstructure by high-resolution peripheral quantitative computed tomography (HR-pQCT). MATERIAL AND METHODS Data of 29 adult OI patients were retrospectively analyzed. Standard radiographs of the thoracic and lumbar spine were evaluated using the TX-Analyzer™. Bone Structure Value (BSV), Bone Variance Value (BVV), and Bone Entropy Value (BEV) were measured at the vertebral bodies T7 to L5. Data were compared to a healthy, age- and gender-matched control group (n = 58). BMD by DXA, TBS, and trabecular bone microstructure by means of HR-pQCT were correlated to TX-Analyzer™ parameters in OI patients. The accuracy of the TX-Analyzer™ parameters in detecting OI was assessed with area under curve (AUC) analysis of receiver operating characteristic (ROC). RESULTS BEV of the thoracic and the lumbar spine were significantly lower in OI patients compared to controls (both p < 0.001). BEV of the thoracic spine was significantly correlated to TBS (ρ = 0.427, p = 0.042) as well as trabecular number (Tb.N) at the radius (ρ = 0.603, p = 0.029) and inhomogeneity of the trabecular network (Tb.1/N.SD) at the radius (ρ = -0.610, p = 0.027), when assessed by HR-pQCT. No correlations were found between BEV and BMD by DXA. BEV of the thoracic and the lumbar spine had an AUC of 0.81 (95% confidence interval [CI] 0.67-0.94, p < 0.001) and 0.73 (95% CI 0.56-0.89, p = 0.008), respectively. BSV and BVV did not differ between OI patients and controls. CONCLUSION The software TX-Analyzer™ is able to discriminate patients with OI from healthy controls. ROC curves of BEV values suggest a suitable clinical applicability. Low to no correlations with conventional methods suggest, that the TX-Analyzer™ may indicate a new and independent examination tool in OI.
Collapse
Affiliation(s)
- Jakob E Schanda
- AUVA Trauma Center Vienna-Meidling, Department for Trauma Surgery, Vienna, Austria; Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Vienna, Austria; Austrian Cluster for Tissue Regeneration, Vienna, Austria
| | - Stephanie Huber
- Ludwig Boltzmann Institute of Osteology at Hanusch Hospital of OEGK and AUVA Trauma Center Vienna-Meidling, Vienna, Austria
| | - Martina Behanova
- Ludwig Boltzmann Institute of Osteology at Hanusch Hospital of OEGK and AUVA Trauma Center Vienna-Meidling, Vienna, Austria
| | - Judith Haschka
- Ludwig Boltzmann Institute of Osteology at Hanusch Hospital of OEGK and AUVA Trauma Center Vienna-Meidling, Vienna, Austria; St. Vincent Hospital Vienna, II Medical Department, Vienna, Austria; Hanusch Hospital Vienna, I Medical Department, Vienna, Austria
| | - Daniel A Kraus
- Ludwig Boltzmann Institute of Osteology at Hanusch Hospital of OEGK and AUVA Trauma Center Vienna-Meidling, Vienna, Austria
| | | | - Arian Bahrami
- Hanusch Hospital Vienna, Department of Radiology and Nuclear Medicine, Vienna, Austria
| | - Shahin Zandieh
- Hanusch Hospital Vienna, Department of Radiology and Nuclear Medicine, Vienna, Austria
| | | | - Heinrich Resch
- St. Vincent Hospital Vienna, II Medical Department, Vienna, Austria; Sigmund Freud University Vienna, Medical Faculty of Bone Diseases, Vienna, Austria
| | - Matthias Mähr
- Ludwig Boltzmann Institute of Osteology at Hanusch Hospital of OEGK and AUVA Trauma Center Vienna-Meidling, Vienna, Austria
| | - Katharina Rötzer
- Hanusch Hospital Vienna, Department of Medical Genetics, Vienna, Austria; Sigmund Freud University, Medical Faculty of Genetics, Vienna, Austria
| | - Göykan Uyanik
- Hanusch Hospital Vienna, Department of Medical Genetics, Vienna, Austria; Sigmund Freud University, Medical Faculty of Genetics, Vienna, Austria
| | - Jochen Zwerina
- Ludwig Boltzmann Institute of Osteology at Hanusch Hospital of OEGK and AUVA Trauma Center Vienna-Meidling, Vienna, Austria; Hanusch Hospital Vienna, I Medical Department, Vienna, Austria
| | - Roland Kocijan
- Ludwig Boltzmann Institute of Osteology at Hanusch Hospital of OEGK and AUVA Trauma Center Vienna-Meidling, Vienna, Austria; Hanusch Hospital Vienna, I Medical Department, Vienna, Austria; Sigmund Freud University Vienna, Medical Faculty of Bone Diseases, Vienna, Austria.
| |
Collapse
|
38
|
Abstract
Denosumab (DMAB) is a potent antiresorptive treatment used for treatment of osteoporosis and low bone mineral density (BMD) in those at high risk for fracture. In postmenopausal women with osteoporosis, DMAB treatment for 10 years has been studied, with results showing continued gains in BMD, sustained fracture risk reduction, and low risk of adverse events. However, upon discontinuation of DMAB, there is a rapid reversal of effect, with increase in bone turnover, loss of BMD, and in a subset of patients, a greater risk for multiple vertebral fractures.
Collapse
Affiliation(s)
- Meltem Zeytinoglu
- Section of Adult and Pediatric Endocrinology, Diabetes, and Metabolism, Department of Medicine, University of Chicago, 5841 South Maryland Avenue, AMB M267, Chicago, IL 60637, USA.
| | - Sandra C Naaman
- Section of General Internal Medicine, Department of Medicine, University of Chicago, 355 East Grand Street, Chicago, IL 60611, USA
| | - Laura T Dickens
- Section of Adult and Pediatric Endocrinology, Diabetes, and Metabolism, Department of Medicine, University of Chicago, 5841 South Maryland Avenue, AMB M267, Chicago, IL 60637, USA
| |
Collapse
|
39
|
Briot K, Schott AM, Sanchez JP, Chauny JV, Samama P, Désaméricq G. High persistence over two years with denosumab among postmenopausal women with osteoporosis in France: A prospective cohort study. Bone 2021; 146:115890. [PMID: 33610904 DOI: 10.1016/j.bone.2021.115890] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 01/13/2021] [Accepted: 02/13/2021] [Indexed: 12/19/2022]
Abstract
PURPOSE To assess the 12 and 24-month persistence with denosumab in postmenopausal women with osteoporosis in real-world clinical practice in France, and to describe characteristics and management of these patients. METHODS This prospective, multicenter cohort study evaluated persistence with denosumab at 12 months (primary endpoint) and 24 months (secondary endpoint), defined as at least 2 or 4 injections respectively, and time elapsed between 2 consecutive injections did not exceed 6 months +8 weeks. Other endpoints included patients' characteristics at baseline, medical history, concomitant and previous treatments, and incidence of adverse drug reactions (ADR), serious adverse events and fractures. RESULTS 478 patients were enrolled by 86 physicians between June 2015 and February 2016. The mean follow-up was 28 months. Mean age was 72 years and 91% of patients had been previously treated for osteoporosis. The persistence with denosumab was 86% (95%CI: 83%-89%) at 12 months and 72% (95%CI: 68%-76%) at 24 months. Using the Kaplan-Meier estimates, the persistence probability over time was 86% at 12 months and 76% at 24 months. During the study, 78 patients discontinued therapy. No multiple vertebral fractures were reported upon discontinuation. ADR were reported for 55 patients, 4 being serious, and 27 patients discontinued denosumab due to an ADR. Among patients who received at least one injection, 10 died. None of the deaths were attributable to denosumab. CONCLUSION Persistence with denosumab at 12 and 24 months was high, and the treatment was well tolerated among postmenopausal women with osteoporosis treated in routine clinical practice in France.
Collapse
Affiliation(s)
- Karine Briot
- Department of Rheumatology, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Anne-Marie Schott
- Universite Claude Bernard Lyon 1, EA 7425 HeSPeR, Hospices Civils de Lyon, Pôle de Santé Publique, Lyon, France
| | | | | | | | | |
Collapse
|
40
|
Marasco E, Mussa M, Motta F, Bobbio-Pallavicini F, Maserati R, Montecucco C, Bogliolo L. Denosumab for the treatment of HIV-associated osteoporosis with fractures in a premenopausal woman. Reumatismo 2021; 73:54-58. [PMID: 33874648 DOI: 10.4081/reumatismo.2021.1358] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 11/29/2020] [Indexed: 11/23/2022] Open
Abstract
The prevalence of osteoporosis is about three times greater in people living with HIV than in the general population. Bisphosphonates are the only class of antiresorptive drugs which have proved to be safe and effective in HIV patients. However, bisphosphonates are not recommended in women of childbearing age due to an increased rate of associated neonatal complications. To the best of our knowledge no reports on the use of denosumab in HIV-infected individuals have been published so far. We describe a 38 year-old woman with HIV, osteoporosis and vertebral fractures treated with denosumab, a monoclonal antibody targeting RANKL. After four years of treatment, bone mineral density improved, no new fractures occurred, and neither HIV reactivation nor opportunistic infections were observed. We show that denosumab could be a safe and effective approach for osteoporosis in patients with HIV and could be considered in women of childbearing age.
Collapse
Affiliation(s)
- E Marasco
- Unit of Rheumatology, Policlinico San Matteo IRCCS Foundation, University of Pavia.
| | - M Mussa
- Infectious Disease Department, Policlinico San Matteo IRCCS Foundation, Pavia.
| | - F Motta
- Unit of Rheumatology, Policlinico San Matteo IRCCS Foundation, University of Pavia.
| | - F Bobbio-Pallavicini
- Unit of Rheumatology, Policlinico San Matteo IRCCS Foundation, University of Pavia.
| | - R Maserati
- Infectious Disease Department, Policlinico San Matteo IRCCS Foundation, Pavia.
| | - C Montecucco
- Unit of Rheumatology, Policlinico San Matteo IRCCS Foundation, University of Pavia.
| | - L Bogliolo
- Unit of Rheumatology, Policlinico San Matteo IRCCS Foundation, University of Pavia.
| |
Collapse
|
41
|
Everts-Graber J, Reichenbach S, Gahl B, Ziswiler HR, Studer U, Lehmann T. Risk factors for vertebral fractures and bone loss after denosumab discontinuation: A real-world observational study. Bone 2021; 144:115830. [PMID: 33359006 DOI: 10.1016/j.bone.2020.115830] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 12/11/2020] [Accepted: 12/17/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Denosumab discontinuation without subsequent bisphosphonates (BPs) is associated with bone loss and multiple vertebral fractures. OBJECTIVE Identifying risk factors for bone loss and vertebral fractures after denosumab discontinuation. METHODS This retrospective study measured the outcome of 219 women with osteoporosis who discontinued denosumab treatment and received subsequent treatment with zoledronate, other BPs or a selective estrogen receptor modulator (SERM), or no therapy. Fracture rate, longitudinal bone mineral density (BMD) changes and bone turnover markers (BTMs) within 2 years after denosumab discontinuation were analysed. Linear regression analysis evaluated loss of BMD and age, BMI (kg/m2), denosumab treatment duration, pre-treatment, prior fracture state, baseline T-scores, use of glucocorticoids or aromatase inhibitors and BMD gains under denosumab therapy. RESULTS 171 women received zoledronate after denosumab discontinuation, 26 had no subsequent treatment and 22 received other therapies (other BPs or a SERM). Zoledronate was associated with the fewest vertebral fractures (hazard ratio 0.16, p = 0.02) and all subsequent therapies retained BMD at all sites to some extent. Higher BMD loss was associated with younger age, lower BMI, longer denosumab treatment, lack of prior antiresorptive treatment and BMD gain under denosumab treatment. BTM levels correlated with denosumab treatment duration and bone loss at the total hip, but not the lumbar spine. CONCLUSIONS Compared to no subsequent therapy, zoledronate was associated with fewer vertebral fractures after denosumab. Further, BMD loss depended on denosumab treatment duration, age, prior BP therapy and BMD gain under denosumab therapy, whereas BTM levels were associated with bone loss at the total hip and denosumab treatment duration.
Collapse
Affiliation(s)
| | - S Reichenbach
- Department of Rheumatology, Immunology and Allergology, University Hospital, Bern, Switzerland; Institute for Social and Preventive Medicine, University of Bern, Switzerland
| | - B Gahl
- Clinical Trial Unit (CTU) Bern, University of Bern, Switzerland
| | - H R Ziswiler
- OsteoRheuma Bern, Bahnhofplatz 1, Bern, Switzerland
| | - U Studer
- OsteoRheuma Bern, Bahnhofplatz 1, Bern, Switzerland
| | - T Lehmann
- OsteoRheuma Bern, Bahnhofplatz 1, Bern, Switzerland
| |
Collapse
|
42
|
Marocco C, Zimatore G, Mocini E, Fornari R, Iolascon G, Gallotta MC, Bimonte VM, Baldari C, Lenzi A, Migliaccio S. Efficacy of Denosumab Therapy Following Treatment with Bisphosphonates in Women with Osteoporosis: A Cohort Study. Int J Environ Res Public Health 2021; 18:ijerph18041728. [PMID: 33579002 PMCID: PMC7916792 DOI: 10.3390/ijerph18041728] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 02/03/2021] [Accepted: 02/04/2021] [Indexed: 01/02/2023]
Abstract
Denosumab is a human monoclonal antibody that neutralizes RANKL, a cytokine able to interact with the RANK receptor on preosteoclasts and osteoclasts, decreasing their recruitment and differentiation, leading to a decreased bone resorption. The aim of this observational real-life study was to analyze adherence to denosumab therapy and assess its efficacy in increasing bone mineral density (BMD) and modulating biochemical skeletal markers following previous treatments with bisphosphonates in a group of post-menopausal women with osteoporosis. Women were recruited in the specialized center from March 2012 to September 2019. Biochemical markers were recorded at baseline and every six months prior to subsequent drug injection. Dual X-ray absorptiometry was requested at baseline and after 18/24 months. Comparing BMD at baseline and after denosumab therapy in naive patients and in those previously treated with bisphosphonates, a positive therapeutic effect was observed in both groups. The results of our real-life study demonstrate, as expected, that BMD values significantly increased upon denosumab treatment. Interestingly, denosumab showed an increased efficacy in patients previously treated with bisphosphonates. Moreover, biochemical markers data indicate that osteoporotic patients, without other concomitant unstable health conditions, could be evaluated once a year, decreasing the number of specialistic center access.
Collapse
Affiliation(s)
- Chiara Marocco
- Department of Movement, Human and Health Sciences, Health Sciences Section, University Foro Italico of Rome, 00135 Rome, Italy; (C.M.); (V.M.B.)
| | - Giovanna Zimatore
- Department of Movement, Human and Health Sciences, Health Sciences Section, University Foro Italico of Rome, 00135 Rome, Italy; (C.M.); (V.M.B.)
- Department of Theoretical and Applied Sciences, eCampus University, 22060 Novedrate, Italy;
- IMM-CNR, Institute for Microelectronics and Microsystems, 40129 Bologna, Italy
- Correspondence: (G.Z.); (S.M.)
| | - Edoardo Mocini
- Department of Experimental Medicine, Medical Pathophysiology, Endocrinology and Nutrition Section, University Sapienza of Rome, 00185 Rome, Italy; (E.M.); (R.F.); (A.L.)
| | - Rachele Fornari
- Department of Experimental Medicine, Medical Pathophysiology, Endocrinology and Nutrition Section, University Sapienza of Rome, 00185 Rome, Italy; (E.M.); (R.F.); (A.L.)
| | - Giovanni Iolascon
- Department of Medical and Surgical Specialties and Dentistry, University of Campania “Luigi Vanvitelli”, 81100 Caserta, Italy;
| | - Maria Chiara Gallotta
- Department of Physiology and Pharmacology “Vittorio Erspamer”, Sapienza University of Rome, 00185 Rome, Italy;
| | - Viviana Maria Bimonte
- Department of Movement, Human and Health Sciences, Health Sciences Section, University Foro Italico of Rome, 00135 Rome, Italy; (C.M.); (V.M.B.)
| | - Carlo Baldari
- Department of Theoretical and Applied Sciences, eCampus University, 22060 Novedrate, Italy;
| | - Andrea Lenzi
- Department of Experimental Medicine, Medical Pathophysiology, Endocrinology and Nutrition Section, University Sapienza of Rome, 00185 Rome, Italy; (E.M.); (R.F.); (A.L.)
| | - Silvia Migliaccio
- Department of Movement, Human and Health Sciences, Health Sciences Section, University Foro Italico of Rome, 00135 Rome, Italy; (C.M.); (V.M.B.)
- Correspondence: (G.Z.); (S.M.)
| |
Collapse
|
43
|
Migliorini F, Colarossi G, Baroncini A, Eschweiler J, Tingart M, Maffulli N. Pharmacological Management of Postmenopausal Osteoporosis: a Level I Evidence Based - Expert Opinion. Expert Rev Clin Pharmacol 2021; 14:105-119. [PMID: 33183112 DOI: 10.1080/17512433.2021.1851192] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Objectives: Postmenopausal osteoporosis carries a high risk of fractures, which decrease quality of life and are associated with high morbidity, mortality, and economic burden. The best pharmacological treatment options to manage and prevent osteoporotic fractures remain still unclear. The present study investigated the efficacy and safety of the most commonly employed drugs in the management of postmenopausal osteoporosis. Methods: Only RCTs comparing different drugs for the management of postmenopausal osteoporosis were included. Data from 76 RCTs (205,011 patients) were collected. The mean follow-up was 27.6 ± 14.9 months. Results: Denosumab reported the lowest rate of non-vertebral fractures (LOR -1.57), Romosozumab the lowest rate of vertebral fractures (LOR 1.99), and Ibandronate the lowest rate of hip fractures (LOR0.18). Serious adverse events resulted in the lowest in the Raloxifene group (LOR 3.11), while those leading to study discontinuation were lowest in the Romosozumab cohort (LOR 2.65). Conclusions: Denosumab resulted in most effective, particularly in reducing the occurrence of non-vertebral fractures. Romosozumab and Ibandronate resulted best to prevent, respectively, vertebral fractures and hip fractures. Adverse events leading to study discontinuation were less frequent in the Romosozumab and Denosumab groups, while Raloxifene and Alendronate showed a lower incidence of serious adverse events overall. Level of evidence: I, Bayesian network meta-analysis of RCTs.
Collapse
Affiliation(s)
- Filippo Migliorini
- Department of Orthopaedics, University Clinic Aachen, RWTH Aachen University Clinic , Aachen, Germany
| | - Giorgia Colarossi
- Department of Cardiac and Thoracic Surgery, University Clinic Aachen, RWTH Aachen University Clinic , Aachen, Germany
| | - Alice Baroncini
- Department of Orthopaedics, University Clinic Aachen, RWTH Aachen University Clinic , Aachen, Germany
| | - Jörg Eschweiler
- Department of Orthopaedics, University Clinic Aachen, RWTH Aachen University Clinic , Aachen, Germany
| | - Markus Tingart
- Department of Orthopaedics, University Clinic Aachen, RWTH Aachen University Clinic , Aachen, Germany
| | - Nicola Maffulli
- Department of Medicine, Surgery and Dentistry, University of Salerno , Baronissi (SA), Italy.,Queen Mary University of London , Barts and London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, London, UK.,School of Pharmacy and Bioengineering , Keele University Faculty of Medicine, Stoke on Trent, UK
| |
Collapse
|
44
|
Mori Y, Izumiyama T, Mori N, Aizawa T. The Effect of Teriparatide for the Treatment of Multiple Spontaneous Clinical Vertebral Fractures after Discontinuation of Denosumab in a Female Patient with Rheumatoid Arthritis: A Case Report. TOHOKU J EXP MED 2021; 254:57-61. [PMID: 34053968 DOI: 10.1620/tjem.254.57] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Discontinuation of denosumab is associated with the risk of rebound in bone turnover and rebound-associated spontaneous clinical vertebral fractures. This case report presents an 86-year-old woman with rheumatoid arthritis who experienced rebound-associated spontaneous clinical vertebral fractures at 9 months after denosumab discontinuation. Following 5-year bisphosphonate treatment, the patient had 9 injections of 60-mg denosumab every 6 months. Because of tooth extraction, denosumab treatment was discontinued, and raloxifene was administered. At 9 months after the last denosumab injection, the patient experienced severe low back pain. Magnetic resonance imaging (MRI) and radiograph demonstrated clinical fracture at the fourth lumbar vertebra. MRI performed at 3 months after first fracture showed two additional fractures at the second and third lumbar vertebrae. Teriparatide was administered for management of rebound-associated spontaneous clinical, multiple vertebral fractures. Teriparatide was effective for accelerating the fracture healing and suppressing the occurrence of new fractures. However, 2-year treatment of teriparatide did not have suppressive effect of rebound in bone turnover and general bone loss. This case suggested that teriparatide was effective for suppression of new rebound-associated spontaneous clinical vertebral fractures, but not effective in prevention of general bone loss after denosumab discontinuation.
Collapse
Affiliation(s)
- Yu Mori
- Department of Orthopaedic Surgery, Tohoku University Graduate School of Medicine
| | - Takuya Izumiyama
- Department of Orthopaedic Surgery, Tohoku University Graduate School of Medicine
| | - Naoko Mori
- Department of Diagnostic Radiology, Tohoku University Graduate School of Medicine
| | - Toshimi Aizawa
- Department of Orthopaedic Surgery, Tohoku University Graduate School of Medicine
| |
Collapse
|
45
|
Noble JA, McKenna MJ, Crowley RK. Should denosumab treatment for osteoporosis be continued indefinitely? Ther Adv Endocrinol Metab 2021; 12:20420188211010052. [PMID: 34104392 PMCID: PMC8072936 DOI: 10.1177/20420188211010052] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 03/24/2021] [Indexed: 12/15/2022] Open
Abstract
Denosumab was approved for the treatment of postmenopausal osteoporosis in 2010, based on the FREEDOM study, which indicated a benefit in terms of increased bone mineral density and reduced risk of major osteoporotic fracture. In the initial clinical studies it was noted that discontinuation of denosumab can lead to a rebound of bone turnover markers and loss of accrued bone mineral density. An increased risk of fractures (multiple vertebral fractures in particular) associated with discontinuation was noted after approval and marketing of denosumab. For many patients experiencing gain in bone mineral density and fracture prevention while taking denosumab, there is no reason to stop therapy. However, discontinuation of denosumab may happen due to non-adherence; potential lack of efficacy in an individual; where reimbursement for therapy is limited to those with bone mineral density in the osteoporosis range, when assessment reveals this has been exceeded; or patient or physician concern regarding side effects. This review paper aims to discuss these concerns and to summarize the data available to date regarding sequential osteoporosis therapy following denosumab cessation to reduce the risk of multiple vertebral fracture.
Collapse
Affiliation(s)
- Jane A. Noble
- Department of Endocrinology, St Vincent’s University Hospital, Dublin, Ireland
| | - Malachi J. McKenna
- St Vincent’s Private Hospital, Dublin, Ireland
- School of Medicine and Medical Science, University College Dublin, Belfield, Dublin, Ireland
| | | |
Collapse
|
46
|
Okubo N, Matsui S, Matsumoto T, Sugimoto T, Hosoi T, Osakabe T, Watanabe K, Takami H, Shiraki M, Nakamura T. Relationship Between Bone Mineral Density and Risk of Vertebral Fractures with Denosumab Treatment in Japanese Postmenopausal Women and Men with Osteoporosis. Calcif Tissue Int 2020; 107:559-566. [PMID: 32839843 DOI: 10.1007/s00223-020-00750-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 08/11/2020] [Indexed: 01/22/2023]
Abstract
In this post hoc analysis of the Denosumab Fracture Intervention Randomized Placebo-Controlled Trial (DIRECT) in Japanese postmenopausal women and men with osteoporosis, we evaluated the relationship between vertebral fracture risk and both bone mineral density (BMD) T-score and percent change after 24 months of denosumab treatment at total hip, femoral neck, and lumbar spine. Logistic regression analysis was performed and the proportion of treatment effect explained by BMD in vertebral fracture risk was estimated. The results demonstrate that both total hip BMD T-score and change can be strong predictors of subsequent fracture risk, and that total hip BMD change explained 73%, while T-score explained 23%, of the treatment effect. In contrast, neither femoral neck BMD change nor T-score can predict the effect of denosumab on vertebral fracture risk. Furthermore, although lumbar spine BMD T-score was associated with vertebral fracture incidence, lumbar spine BMD change was inversely related to vertebral fracture risk. Because there was no relationship between lumbar spine BMD change and T-score at 24 months of denosumab treatment, and because there can be small undetectable vertebral deformities that may increase BMD values, these results suggest that lumbar spine BMD change is not a good surrogate for vertebral fracture risk assessment. It is suggested that both total hip BMD change and T-score can be good surrogates for predicting vertebral fracture risk in Japanese patients with osteoporosis under denosumab treatment.ClinicalTrials.gov identifier: NCT00680953.
Collapse
Affiliation(s)
| | | | - Toshio Matsumoto
- Fujii Memorial Institute of Medical Sciences, Institute of Advanced Medical Sciences, Tokushima University, Tokushima, Japan
| | | | | | | | | | | | - Masataka Shiraki
- Research Institute and Practice for Involutional Diseases, Nagano, Japan
| | | |
Collapse
|
47
|
Abstract
Postmenopausal osteoporosis is a common condition and is associated with increased risk of fracture, including hip and vertebral fractures that in turn can have devastating consequences on morbidity and mortality. In this article, we review the pathogenesis and diagnostic approach to postmenopausal osteoporosis. We review available nonpharmacologic and pharmacologic therapies and we discuss their clinical efficacy and complications, with a detailed discussion of atypical femur fractures and osteonecrosis of the jaw.
Collapse
|
48
|
Langdahl B. Treatment of postmenopausal osteoporosis with bone-forming and antiresorptive treatments: Combined and sequential approaches. Bone 2020; 139:115516. [PMID: 32622871 DOI: 10.1016/j.bone.2020.115516] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 06/08/2020] [Accepted: 06/29/2020] [Indexed: 12/26/2022]
Abstract
Efficient therapies are available for the treatment of osteoporosis. Bisphosphonates and denosumab are the most commonly used antiresorptive therapies. Despite differences in the increase in bone mineral density seen with these drugs, the reductions in fracture risk are similar; 50-70%, 20%, and 40% for vertebral, non-vertebral and hip fractures, respectively. The bone-forming treatments; teriparatide and abaloparatide increase bone mineral density more than the antiresorptives and the reductions in fracture risk are 85% and 40-50% for vertebral and non-vertebral fractures, respectively, compared to placebo. The VERO study demonstrated a >50% reduction in vertebral and clinical fractures in women treated with teriparatide compared to risedronate. The dual-action treatment; romosozumab leads to more pronounced increases in BMD than other treatment modalities and reduces the risk of vertebral and clinical fractures by 73% and 36% compared to placebo after 12 months and the sequential treatment regime; romosozumab for 12 months followed by alendronate reduced the risk of vertebral, non-vertebral and hip fractures by 48%, 20% and 38%, respectively compared to alendronate after 2-3 years. The evidence for combination therapy targeting both resorption and formation is limited as only short-term studies with BMD as the endpoint have been performed. All bone-forming and dual-action treatments increase BMD and reduce the fracture risk, however, the effect wears off with time and treatment is therefore only temporary and should be followed by antiresorptive treatment with a bisphosphonate or denosumab. The sequence of treatment matters as the BMD response to teriparatide is reduced in patients previously treated with bisphosphonates; however, based on the findings of the VERO trial, the anti-fracture efficacy of bone-forming treatment in comparison with risedronate seems to be preserved after bisphosphonate therapy. The DATA study suggested that transitioning from denosumab to teriparatide is problematic due to the increase in bone resorption occurring after stopping denosumab. Studies have shown further improvements in BMD when transitioning from oral bisphosphonates to zoledronic acid or denosumab. Management of osteoporosis will in many patients include a long-term treatment plan. This will often include sequential therapy which in severe cases preferably should start with bone-forming followed by antiresorptive treatment. The severity of osteoporosis, reaching a treatment goal, and responding to treatment failure are important factors determining the treatment sequence in the individual patient.
Collapse
Affiliation(s)
- Bente Langdahl
- Aarhus University Hospital, Endocrinology and Internal Medicine, Palle Juul Jensen Boulevard 115, DK8200 Aarhus N, Denmark.
| |
Collapse
|
49
|
Pang KL, Low NY, Chin KY. A Review on the Role of Denosumab in Fracture Prevention. Drug Des Devel Ther 2020; 14:4029-4051. [PMID: 33061307 PMCID: PMC7534845 DOI: 10.2147/dddt.s270829] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Accepted: 08/19/2020] [Indexed: 12/13/2022]
Abstract
Denosumab is a receptor activator of nuclear factor kappa-Β ligand inhibitor, which suppresses the bone resorption process to preserve bone mass. It is usually recommended to postmenopausal women and men with high fracture risk. With the recent publication of the results from FREEDOM study and its extension, the long-term effect of denosumab in preventing fragility fractures has been put forward. This review aims at summarising the evidence of denosumab in reducing fracture risk and its safety derived from clinical studies. Most of the evidence are derived from FREEDOM trials up to 10 years of exposure. Denosumab is reported to prevent vertebral and non-vertebral fractures. It is also proven effective in Japanese women, patients with chronic kidney diseases and breast cancer patients receiving antineoplastic therapy. Denosumab discontinuation leads to high remodeling, loss of bone mineral density and increased fracture risk. These negative effects might be preventable by bisphosphonate treatment. The safety profile of denosumab is consistent with increased years of exposure. In conclusion, denosumab is a safe and effective option for reducing fracture risk among patients with osteoporosis.
Collapse
Affiliation(s)
- Kok-Lun Pang
- Department of Pharmacology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Nie Yen Low
- Department of Pharmacology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Kok-Yong Chin
- Department of Pharmacology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia.,State Key Laboratory of Oncogenes and Related Genes, Renji-Med X Clinical Stem Cell Research Center, Department of Urology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200030, People's Republic of China
| |
Collapse
|
50
|
Heckmann ND, Yang J, DeBenedetti A, Della Valle CJ. Atypical Subtrochanteric Femur Fracture and Hip Osteoarthritis Treated with a Revision Monoblock Stem and Strut Allograft: A Case Report. JBJS Case Connect 2020; 10:e2000038. [PMID: 32960023 DOI: 10.2106/jbjs.cc.20.00038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE A 73-year-old woman was diagnosed with a nondisplaced incomplete atypical bisphosphonate-related subtrochanteric femur fracture and ipsilateral hip osteoarthritis. She was treated with a total hip arthroplasty using a monoblock revision stem and a strut allograft to provide adjunctive mechanical and biological support. At the final follow-up, the patient had no pain, the stem was well fixed, and the allograft strut had incorporated; however, a persistent fracture line was noted. CONCLUSION When an atypical femur fracture coexists with hip osteoarthritis, total hip arthroplasty may be a reasonable treatment option to address the fracture and concomitant hip osteoarthritis with a single surgical intervention. However, consideration should be given to using a stem with distal fixation and augmenting the construct with a strut allograft.
Collapse
Affiliation(s)
- Nathanael D Heckmann
- 1Department of Orthopaedic Surgery, Keck Medicine of USC, Los Angeles, California 2Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
| | | | | | | |
Collapse
|