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J Clin Endocrinol Metab. 2020 May 1;105(5). pii: dgz321. doi: 10.1210/clinem/dgz321.

Delayed Denosumab Injections and Bone Mineral Density Response: An Electronic Health Record-based Study.

Author information

1
Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Boston, Massachusetts, USA.
2
Harvard Medical School, Boston, Massachusetts, USA.
3
National Clinical Research Center for Musculoskeletal Diseases, Beijing, China.
4
Department of Orthopedics, General Hospital of Chinese PLA, Beijing, China.
5
Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool,, UK.
6
Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.
7
Endocrine Unit, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.
8
Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.

Abstract

CONTEXT:

Discontinuation of denosumab leads to a rapid reversal of its therapeutic effect. However, there are no data regarding how unintended delays or missed injections of denosumab impact bone mineral density (BMD) response.

OBJECTIVE:

We examined the association of delays in injections of denosumab with BMD change.

DESIGN:

We used electronic medical records from two academic hospitals from 2010 to 2017.

PARTICIPANTS:

Patients older than 45 years of age and used at least 2 doses of 60 mg denosumab. Denosumab adherence was evaluated by the medication coverage ratio (MCR). Good adherence corresponds to a dosing interval ≤7 months (defined by MCR ≥93%), moderate adherence corresponds to an interval of 7 to 10 months (MCR 75%-93%), and poor adherence corresponds to an interval ≥10 months (MCR ≤75%).

OUTCOME MEASURES:

Annualized percent BMD change from baseline at the lumbar spine, total hip, and femoral neck.

RESULTS:

We identified 938 denosumab injections among 151 patients; the mean (SD) age was 69 (10) years, and 95% were female. Patients with good adherence had an annualized BMD increase of 3.9% at the lumbar spine, compared with patients with moderate (3.0%) or poor adherence (1.4%, P for trend .002). Patients with good adherence had an annualized BMD increase of 2.1% at the total hip, compared with patients with moderate (1.3%) or poor adherence (0.6%, P for trend .002).

CONCLUSIONS:

A longer interval between denosumab injections is associated with suboptimal BMD response at both spine and total hip. Strategies to improve the timely administration of denosumab in real-world settings are needed.

KEYWORDS:

Osteoporosis; bone mineral density; denosumab; dosing delay

PMID:
31894244
PMCID:
PMC7089847
[Available on 2021-01-02]
DOI:
10.1210/clinem/dgz321

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