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Osteoporos Int. 2019 Sep;30(9):1855-1864. doi: 10.1007/s00198-019-05020-8. Epub 2019 Jun 14.

Long-term denosumab treatment restores cortical bone loss and reduces fracture risk at the forearm and humerus: analyses from the FREEDOM Extension cross-over group.

Author information

1
College of Physicians and Surgeons, Columbia University, New York, NY, USA. jpb2@cumc.columbia.edu.
2
Amgen Inc., Thousand Oaks, CA, USA.
3
CHU de Québec Research Centre and Laval University, Quebec City, QC, Canada.
4
Department of Medicine, Monash University, Clayton, Australia.
5
Medical University, Graz, Austria.
6
Mossakowski Medical Research Center, Polish Academy of Sciences, Warsaw, Poland.
7
The Burwood Hospital, Christchurch, New Zealand.
8
Colorado Center for Bone Research, Golden, CO, USA.
9
George Washington University, Washington, DC, USA.
10
Center for Clinical and Basic Research, Tallinn, Estonia.
11
Centro Paulista de Investigação Clinica, São Paulo, Brazil.

Abstract

Upper limb fractures (including wrist, forearm, and humerus) represent a significant burden among postmenopausal women with osteoporosis. Up to 7 years of treatment with denosumab resulted in an increase in bone mineral density and decrease in fractures in upper limb sites.

INTRODUCTION:

Upper limb (wrist, forearm, and humerus) fractures are a significant burden in osteoporosis, associated with significant morbidity and mortality. Denosumab, a monoclonal antibody against RANK ligand, increases bone mineral density (BMD) and decreases vertebral, nonvertebral, and hip fractures. Here, we evaluated the long-term effect of denosumab treatment on upper limb fracture risk and BMD.

METHODS:

In the FREEDOM trial, subjects were randomized 1:1 to receive every-6-month denosumab 60 mg or placebo subcutaneously for 3 years, after which all subjects could receive denosumab for up to 7 years (Extension). Among placebo subjects who completed FREEDOM and enrolled in the Extension, wrist, forearm, humerus, and upper limb fracture rates and rate ratios between different time periods (FREEDOM years 1-3, Extension years 1-3, and Extension years 4-7) were computed. BMD at the ultradistal radius, 1/3 radius, and total radius was analyzed in a subset of subjects in a BMD substudy.

RESULTS:

This analysis included 2207 subjects (116 in the BMD substudy). Fracture rates decreased over the 7-year Extension; fracture rate ratios between Extension years 4-7 (denosumab) and FREEDOM years 1-3 (placebo) reduced significantly for the wrist (0.57), forearm (0.57), humerus (0.42), and upper limb (0.52; p < 0.05 for all). Percentage increase in BMD from Extension baseline at the ultradistal radius, 1/3 radius, and total radius was significant by Extension year 7 (p < 0.05 for all).

CONCLUSIONS:

Long-term treatment with denosumab decreases upper limb fracture risk and increases forearm BMD, suggesting beneficial effects on both cortical and trabecular bone accruing over time.

KEYWORDS:

BMD; Denosumab; Fractures; Osteoporosis

PMID:
31201481
DOI:
10.1007/s00198-019-05020-8

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