Background Glucocorticoid induced osteoporosis (GIO) is serious problem for raising risk of bone fragile fracture. In general, first choice drug for GIO is bisphosphonate (BPH), however, denosumab (dMAB), a monoclonal antibody of receptor activator of nuclear factor kappa-B ligand, is closed up as a alternative selection for GIO recently.
Objectives The aim of this study is to evaluate effectiveness of dMAB in bone mineral density (BMD) for GIO treatment compared to BPH.
Methods In the patients in whom glucocorticoid steroid (GCs) have been administered for more than three months, who met indication criteria for GIO what was determined by the Japanese Society for Bone and Mineral Research in 2014, that is matrix calculated in adding points of past fracture history, age, dosage of GCs, and BMD value (1), were enrolled. Before March 2013, data was lacking, so patients who have been administrated GCs after April 2013 were picked up. Patients BMD at GCs administration, at 6 months after initial treatment, if drug was changed, also at 6 months after second treatment, for minimum lumbar spine (LS), femoral neck (FN), and greater trochanter (GT) were measured with dual-energy X-ray absorptiometry (DEXA). Patients were classified by drug for initial treatment and second drug if administered. Patients age, initial, average, and total dose of GCs, term length of administration, and BMD and its gain for each chance were compared with Mann-Whitney U-test and Student's paired T-test.
Results 149 patients in whom 48 with no drug administrated (N), 24 for BPH naïve and continued (BB), 22 for BPH naïve and changed to dMAB (BD), 21 for dMAB naïve and continued (DD), 34 for dMAB naïve and changed to BPH (DB) were counted. In these, sex distribution was 26 for men and 123 for women. Underlying disease for administration of GCs were rheumatoid arthritis for 114, polymyalgia rheumatica for 12, idiopathic thrombocytopenic purpura for 9, systemic lupus erythematosus for 6, and others for 8. For groups, age at baseline, initial, average, and total dose, and term length of administration of GCs demonstrated no significant difference between any pairs of the groups. BMD at baseline for Group N demonstrated significant greater per-cent of young adult mean (%YAM) than Group DD (p<0.01) in all parts, yet greater than the other groups but not statistically significant. In Group N, BMD had significantly decreased from the baseline to 6 months later in all parts (p<0.01). In the other groups, BMD had shown gain at 6 months after drug administration in all part, however, in Group DB showed mean %YAM loss for GT after first and second drug administration compared to Group BD had shown %YAM loss after first but gain after second drug for FN (Table 1).
Conclusions From these results, dMAB is effective role in raising BMD for GIO as a initial drug, and a second drug even after inadequate response to BPH. dMAB could be possible to be chosen as a first choice drug for GIO treatment.
Suzuki, Y., Nawata, H., Soen, S. et al. J Bone Miner Metab (2014) 32: 337. doi:10.1007/s00774–014–0586–6.
Disclosure of Interest None declared