Effect of denosumab on trabecular bone score in postmenopausal women with osteoporosis

Abstract

Summary Trabecular bone score (TBS) assesses bone quality in the lumbar spine using dual-energy X-ray absorptiometry (DXA) scans. In postmenopausal women with osteoporosis, denosumab significantly improved TBS independently of bone mineral density (BMD). This practical technique may have a role in managing patients with osteoporosis. Introduction TBS, a gray-level texture index determined from lumbar spine DXA scans, correlates with bone microarchitecture and enhances assessment of vertebral fracture risk independently of BMD. In the FREEDOM study, denosumab increased BMD and reduced new vertebral fractures in postmenopausal women with osteoporosis. This retrospective analysis explored the effect of denosumab on TBS and the association between TBS and BMD in FREEDOM. Methods Postmenopausal women with lumbar spine or total hip BMD T-score <−2.5 and −4.0 or higher at both sites received placebo or denosumab 60 mg subcutaneously every 6 months. TBS indices were determined from DXA scans at baseline and months 12, 24, and 36 in a subset of 285 women (128 placebo, 157 denosumab) who had TBS values at baseline and ≥1 postbaseline visit. Results Baseline characteristics were comparable between treatment groups; mean (SD) lumbar spine BMD T-score was −2.79 (0.64), and mean (standard deviation [SD]) TBS was 1.200 (0.101) overall. In the placebo group, BMD and TBS increased by ≤0.2% or decreased from baseline at each visit. In the denosumab group, progressive increases from baseline at 12, 24, and 36 months were observed for BMD (5.7, 7.8, and 9.8%) and TBS (1.4, 1.9, and 2.4%). Percentage changes in TBS were statistically significant compared with baseline (p < 0.001) and placebo (p ≤ 0.014). TBS was largely unrelated to BMD, regardless of treatment, either at baseline or for annual changes from baseline (all r 2 ≤ 0.06). Conclusions In postmenopausal women with osteoporosis, denosumab significantly improved TBS independently of BMD.

Bone Effect and Safety of One-Year Denosumab Therapy in a Cohort of Renal Transplanted Patients: An Observational Monocentric Study

“…As shown in the results, the increase of BMD compared to the baseline was significant, especially at vertebral level. This result, after only one year of treatment, confirms the good effect of DB on osteoclastic resorption of trabecular structures already evidenced in the general population [ 20 ]. The beneficial effect of DB on BMD was confirmed also by the relative low incidence of novel sVF during the year of treatment.…”

Application of the Trabecular Bone Score in Clinical Practice

“…[ 26 ] In a subgroup analysis of the FREEDOM trial comparing denosumab 60 mg (N=157) to placebo (N=128), the mean increase in TBS in the denosumab group was +2.4% at 36 months, and 80% of patients did not have increased TBS beyond the LSC. [ 27 ] Given that more than half the patients who received antiresorptive treatment - irrespective of potency and route - did not have an increase in TBS beyond the LSC despite an increase in BMD and fracture risk reduction, TBS would not be useful for monitoring patients on antiresorptive agents during the treatment period up to 3 years. It remains to be investigated if a more extended time interval might be necessary to detect significant TBS increase beyond LSC in patients on antiresorptive treatment.…”

Osteosarcopenia in Very Old Age Adults After Hip Fracture: A Real-World Therapeutic Standpoint

“…So far, there is a paucity of data on the role of anti-resorptive drugs on bone microarchitecture in very old individuals, and the present findings seem to support a timely role for alendronate on bone quality compared to denosumab. In contrast with that, denosumab was previously observed to improve TBS independent on BMD in postmenopausal women with osteoporosis ( 42 ). However, it is to underscore that TBS assessment at baseline was slightly statistically unbalanced for the regression of the mean effect, creating an overestimation of the 1-year alendronate effect on TBS.…”