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Elevated parathyroid hormone levels in older women treated for osteoporosis using denosumab

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Key summary points

AbstractSection Aim

To determine factors associated with intact parathyroid hormone (iPTH) elevation in a cohort of postmenopausal women being managed for osteoporosis.

AbstractSection Findings

Age was positively associated with iPTH in older women being treated for osteoporosis with denosumab.

AbstractSection Message

Continuation of denosumab may be safe in lowering the risk of fracture in older women with osteoporosis.

Abstract

Purpose

Primary care physicians (PCPs) often struggle with elevated serum intact parathyroid hormone (iPTH) in osteoporotic patients on antiresorptive treatment, specifically, denosumab. As iPTH and calcium levels need to be within normal ranges to receive the next dose of denosumab, continuously high serum iPTH may necessitate additional tests to rule out pathological causes. We aimed to determine factors associated with iPTH elevation in a cohort of postmenopausal women receiving osteoporosis treatment.

Method

A cross-sectional analysis of electronic medical records of patients 50 years and older who visited a geriatric osteoporosis clinic between October 1, 2014 and December 31, 2019, was conducted. We divided patients into 3 categories: not currently on treatment, on bisphosphonates or on denosumab. Percentage change in iPTH levels from baseline to 1 year follow-up was the outcome measure. Other variables used are age, body mass index, chronic co-morbidities, 25OH-vitamin D, calcium, TSH, glomerular filtration rate and femoral neck BMD. Linear regression models were used to assess independent associations between treatment group and iPTH changes.

Results

Mean (SD) age of 173 participants in our study was 78 (± 10) years, and 71% were Caucasian. At follow-up, mean percent change of iPTH was 13.47 ± 62.76, 30.35 ± 61.17, and 39.60 ± 35.51 in the “no treatment”, “bisphosphonate” and “denosumab” groups, respectively. Age was a predictor of elevated percent change of iPTH in the denosumab group.

Conclusion

Increasing age is associated with iPTH elevations in osteoporotic patients on denosumab. In the absence of any pathology, continuation of denosumab may be safe in lowering fracture risk. However, a larger study may be required to confirm this.

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Availability of data and material

Study data are available from the corresponding author upon reasonable request.

Code availability

Not applicable.

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Funding

Fariha Hameed and Luis Valdez were supported through the Summer Research Program of the Department of Family and Community Medicine, UT McGovern Medical School.

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Authors and Affiliations

  1. Department of Family and Community Medicine, The University of Texas McGovern Medical School, 6431 Fannin St, Suite JJL324, Houston, TX, 77030, USA

    Abayomi N. Ogunwale, Fariha Hameed, Luis Valdez, Jude des Bordes & Nahid Rianon

  2. The University of Texas School of Public Health, Houston, TX, USA

    Maryam Jamil

Authors
  1. Abayomi N. Ogunwale
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  2. Fariha Hameed
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  3. Luis Valdez
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  4. Jude des Bordes
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  5. Maryam Jamil
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  6. Nahid Rianon
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Contributions

Conceptualization: NR; methodology: NR, JdB, AO, FH, LV, MJ; formal analysis and investigation: NR, JdB, AO, FH, LV, MJ; writing—original draft preparation: AO; writing—review and editing: NR, JdB, AO, FH, LV, MJ; approval of final draft: NR, JdB, AO, FH, LV, MJ; supervision: NR.

Corresponding author

Correspondence to Nahid Rianon.

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Conflict of interest

The authors declare no conflicts of interest.

Ethics approval

All procedures performed in this study were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments. The study was exempted from review by the Institutional Review Board (IRB) because it involved no patient contact.

Informed consent

No informed consent were obtained from patients whose records were reviewed.

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Ogunwale, A.N., Hameed, F., Valdez, L. et al. Elevated parathyroid hormone levels in older women treated for osteoporosis using denosumab. Eur Geriatr Med 13, 735–740 (2022). https://doi.org/10.1007/s41999-021-00567-4

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  • DOI: https://doi.org/10.1007/s41999-021-00567-4

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