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Raloxifene Use After Denosumab Discontinuation Partially Attenuates Bone Loss in the Lumbar Spine in Postmenopausal Osteoporosis

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Abstract

Discontinuation of denosumab (DMab) is associated with decline in bone density. Whether raloxifene can be effective to attenuate bone loss after DMab discontinuation in certain conditions when other antiresorptives cannot be used remains unclear. Data on postmenopausal women with osteoporosis who discontinued DMab treatment after short-term use (1-to-4 doses) at Severance Hospital, Seoul, Korea, between 2017 and 2021 were reviewed. Changes in bone mineral density (BMD) at 12 months after DMab discontinuation was compared between sequential raloxifene users (DR) and those without any sequential antiresorptive (DD) after 1:1 propensity score matching. In matched cohort (66 patients; DR n = 33 vs. DD n = 33), mean age (69.3 ± 8.2 years) and T-score (lumbar spine − 2.2 ± 0.7; total hip − 1.6 ± 0.6) did not differ between two groups at the time of DMab discontinuation. Sequential treatment to raloxifene in DR group attenuated the bone loss in lumbar spine after DMab discontinuation compared to DD group (DR vs. DD; − 2.8% vs. − 5.8%, p = 0.013). The effect of raloxifene on lumbar spine BMD changes remained robust (adjusted β + 2.92 vs. DD, p = 0.009) after adjustment for covariates. BMD loss at femoral neck (− 1.70% vs. − 2.77%, p = 0.673) and total hip (− 1.42% vs. − 1.44%, p = 0.992) did not differ between two groups. Compared to BMD at DMab initiation, DR partially retained BMD gain by DMab treatment in lumbar spine (+ 3.7%, p = 0.003) and femoral neck (+ 2.8%, p = 0.010), whereas DD did not. Raloxifene use after DMab treatment attenuated lumbar spine BMD loss in postmenopausal women with short exposures (< 2 years) to DMab.

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Acknowledgements

This study was supported by the ‘SENTINEL (Severance ENdocrinology daTa scIeNcE pLatform)’ Program funded by the 2020 Research fund of Department of Internal Medicine, Severance Hospital, Seoul, Korea, and Sung-Kil Lim Research Award (4-2018-1215; DUCD000002) in statistical analyses.

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  1. Namki Hong and Sungjae Shin contributed equally to this work.

Authors and Affiliations

  1. Department of Internal Medicine, Endocrine Research Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea

    Namki Hong, Sungjae Shin, Seunghyun Lee & Yumie Rhee

  2. Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea

    Kyoung Jin Kim

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Correspondence to Yumie Rhee.

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Namki Hong, Sungjae Shin, Seunghyun Lee, Kyoung Jin Kim, and Yumie Rhee have no relevant financial or non-financial interests to disclose.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the Institutional and/or National Research Committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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This study was approved by Institutional Review Board of Severance Hospital, with a waiver of written consent since the study design was based on retrospective medical record review (IRB No. 4-2021-1346).

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Hong, N., Shin, S., Lee, S. et al. Raloxifene Use After Denosumab Discontinuation Partially Attenuates Bone Loss in the Lumbar Spine in Postmenopausal Osteoporosis. Calcif Tissue Int 111, 47–55 (2022). https://doi.org/10.1007/s00223-022-00962-4

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