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

Abstract

Summary

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.

Introduction

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.

Methods

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.

Results

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.

Conclusions

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.

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Fig. 1

Abbreviations

SCI:

Spinal cord injury

i.v.:

Intravenous

25OHD:

25-Hydroxyvitamin D

BMD:

Bone mineral density

BTMs:

Bone turnover markers

BMI:

Body mass index

ASIA:

American Spinal Cord Injury Association

Bone ALP:

Bone alkaline phosphatase

PINP:

Propeptide amino-terminal of type I procollagen

sCTx:

Serum carboxy-terminal telopeptide of type I collagen

p :

p value

SD:

Standard deviation

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Acknowledgments

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

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Corresponding author

Correspondence to L. Gifre.

Ethics declarations

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

Funding

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

Conflicts of interest

None.

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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Gifre, L., Vidal, J., Carrasco, J.L. et al. Denosumab increases sublesional bone mass in osteoporotic individuals with recent spinal cord injury. Osteoporos Int 27, 405–410 (2016). https://doi.org/10.1007/s00198-015-3333-5

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Keywords

  • Bone mineral density
  • Bone turnover markers
  • Denosumab
  • Osteoporosis
  • Spinal cord injury