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Effects of denosumab as compared with parathyroidectomy regarding calcium, renal, and bone involvement in osteoporotic patients with primary hyperparathyroidism

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Abstract

Purpose

To evaluate the effects of denosumab (Dmb) on calcium, renal, and bone involvement in osteoporotic patients with primary hyperparathyroidism (PHPT) and compare with those who underwent a parathyroidectomy (PTX) procedure.

Methods

This retrospective, longitudinal study included patients treated with Dmb (60 mg) once every 6 months (n = 19) and those who successfully underwent a PTX procedure (n = 19) corrected calcium (cCa), eGFR, bone mineral density (BMD) in the lumbar spine (LS), total hip (TH), and femoral neck (FN) and LS-trabecular bone score (TBS) changes at 1 year after beginning Dmb or undergoing PTX were measured.

Results

Dmb group had older age, and showed milder disease activity and lower eGFR as compared with PTX group. In PTX group, cCa and eGFR were significantly decreased following surgery, while those were stable in Dmb group. There were significant increases in LS, TH, and FN-BMD in both Dmb (LS: 6.0 ± 0.8%, TH: 3.7 ± 1.0%, FN: 4.3 ± 1.5%) and PTX (LS: 11.2 ± 1.5%, TH: 7.5 ± 1.5%, FN: 7.9 ± 2.1%) groups. In Dmb group, LS-TBS was significantly improved by 3.0 ± 1.0%, while TBS change in PTX group approached significance (2.8 ± 1.5%). Percent change in TH-BMD was significantly correlated with baseline tartrate-resistant acid phosphatase-5b (TRACP-5b) in both groups.

Conclusions

Dmb treatment not only increased BMD, dependent on bone turnover status, the same as PTX, but also improved LS-TBS. In addition, it did not decrease the level of eGFR, whereas PTX did. These results suggest that Dmb treatment help in the clinical management of osteoporotic patients with PHPT who do not undergo surgery as alternative to PTX.

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Authors’ contributions

Y.I., and M.I. contributed to the concept and design of the study. D.M. contributed to the acquisition, analysis, and interpretation of data. E.K., N.T., Y.N., M.K., S.Y., and M.E. contributed to the acquisition of data. D.M. was responsible for the integrity of the data analysis. D.M. and Y.I. drafted and revised the paper. All authors have approved the final version of the paper.

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Authors and Affiliations

  1. Department of Metabolism, Endocrinology and Molecular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan

    Daichi Miyaoka, Yasuo Imanishi, Eiko Kato, Norikazu Toi, Yuki Nagata, Masafumi Kurajoh, Shinsuke Yamada, Masaaki Inaba & Masanori Emoto

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  1. Daichi Miyaoka
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  2. Yasuo Imanishi
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Correspondence to Daichi Miyaoka.

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Conflict of interest

M.I. received grant support and lecture fees from Daiichi Sankyo Co., Ltd. Y.I. and M.E. received lecture fees from Daiichi Sankyo Co., Ltd. D.M., E.K., N.T., Y.N., M.K., and S.Y. have no conflicts of interest to report.

Ethics approval

The study protocol was approved by the institutional ethics committee of Osaka City University Graduate School of Medicine (approval No. 2019-072) and conducted in accordance with the principles of the Declaration of Helsinki.

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Miyaoka, D., Imanishi, Y., Kato, E. et al. Effects of denosumab as compared with parathyroidectomy regarding calcium, renal, and bone involvement in osteoporotic patients with primary hyperparathyroidism. Endocrine 69, 642–649 (2020). https://doi.org/10.1007/s12020-020-02401-6

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