Osteoporosis International

, Volume 27, Issue 1, pp 405–410 | Cite as

Denosumab increases sublesional bone mass in osteoporotic individuals with recent spinal cord injury

  • L. Gifre
  • J. Vidal
  • J. L. Carrasco
  • A. Muxi
  • E. Portell
  • A. Monegal
  • N. Guañabens
  • P. Peris
Short Communication



Osteoporosis is a frequent complication related to spinal cord injury (SCI), and data on osteoporosis treatment after SCI is scarce. Treatment with denosumab increases lumbar and femoral BMD and decreases bone turnover markers in individuals with recent SCI. This drug may be a promising therapeutic option in SCI-related osteoporosis.


Osteoporosis development is a frequent complication related to SCI, especially at the sublesional level. Nevertheless, data on osteoporosis treatment after SCI is scarce, particularly short term after injury, when the highest bone loss is produced. The aim of this study was to analyze the efficacy of denosumab in the treatment of SCI-related osteoporosis.


Fourteen individuals aged 39 ± 15 years with osteoporosis secondary to recent SCI (mean injury duration 15 ± 4 months) were treated with denosumab for 12 months. Bone turnover markers (BTMs) (PINP, bone ALP, sCTx), 25-hydroxyvitamin D (25OHD) levels and bone mineral density (BMD) at the lumbar spine (LS), total hip (TH), and femoral neck (FN) were assessed at baseline and at 12 months. All participants received calcium and vitamin D supplementation.


At 12 months, SCI denosumab-treated participants showed a significant increase in BMD at TH (+2.4 ± 3.6 %, p = 0.042), FN (+3 ± 3.6 %, p = 0.006), and LS (+7.8 ± 3.7 %, p < 0.001) compared to baseline values. Denosumab treatment was associated with significant decreases in BTMs (bone ALP −42 %, p < 0.001; PINP −58 %, p < 0.001, sCTx −57 %, p = 0.002) at 12 months. BMD evolution was not related to BTM changes or 25OHD serum levels. No skeletal fractures or serious adverse events were observed during follow-up.


Treatment with denosumab increases lumbar and femoral BMD and decreases bone turnover markers in individuals with recent SCI. This drug may be a promising therapeutic option in SCI-related osteoporosis.


Bone mineral density Bone turnover markers Denosumab Osteoporosis Spinal cord injury 



Spinal cord injury




25-Hydroxyvitamin D


Bone mineral density


Bone turnover markers


Body mass index


American Spinal Cord Injury Association

Bone ALP

Bone alkaline phosphatase


Propeptide amino-terminal of type I procollagen


Serum carboxy-terminal telopeptide of type I collagen


p value


Standard deviation



This work was funded by the Fundació La Marató de TV3.

Compliance with ethical standards

The procedures followed were in accordance with the Ethical Standards of the Helsinki Declaration.


This work was funded by a grant from Fundació La Marató de TV3.

Conflicts of interest


Ethics approval

Ethical approval was obtained from the Hospital Clinic of Barcelona and from the Neurorehabilitation Guttmann Institute Ethics Committees. 

Consent to participate

All participants provided written informed consent prior to the initiation of this study. 


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Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2015

Authors and Affiliations

  • L. Gifre
    • 1
  • J. Vidal
    • 2
  • J. L. Carrasco
    • 3
  • A. Muxi
    • 4
  • E. Portell
    • 2
  • A. Monegal
    • 1
  • N. Guañabens
    • 1
    • 5
  • P. Peris
    • 1
    • 5
  1. 1.Metabolic Bone Diseases Unit, Service of RheumatologyHospital Clinic of BarcelonaBarcelonaSpain
  2. 2.Guttmann Neurorehabilitation InstituteUniversitat Autònoma de BarcelonaBadalonaSpain
  3. 3.Public Health DepartmentUniversity of BarcelonaBarcelonaSpain
  4. 4.Nuclear Medicine DepartmentHospital Clinic of BarcelonaBarcelonaSpain
  5. 5.CIBERehdMadridSpain

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