Beneficial effects of denosumab on muscle performance in patients with low BMD: a retrospective, propensity score-matched study

Abstract

This study examined the effects of denosumab compared to bisphosphonates and vitamin D alone on muscle performance in patients with low BMD. While grip force improved in both the denosumab and bisphosphonate group, a superior increase in chair rising test force was observed in the denosumab group. Introduction The aim of this study was to investigate the effect of the anti-resorptive agent denosumab (Dmab) on upper and lower limb muscle performance compared to bisphosphonate (BP) treatment and vitamin D supplementation alone (i.e., basic therapy) in patients with low BMD. Methods This retrospective, propensity score-matched (sex, age, BMI, follow-up time) cohort study included 150 osteopenic or osteoporotic patients receiving basic (n = 60), BP (n = 30) or Dmab (n = 60) therapy. All patients underwent a musculoskeletal assessment at baseline and follow-up, including DXA, laboratory bone metabolism parameters, grip force, and chair rising test mechanography. Mean annual percentage changes were calculated and compared between study groups. Results After a mean follow-up period of 17.6 ± 9.0 months, a significantly higher increase in grip force in both the Dmab (p < 0.001) and BP group (p = 0.001) compared to the vitamin D group was observed (vitamin D = − 6.1 ± 10.2%; BP = + 0.8 ± 8.2%; Dmab = + 5.1 ± 25.5%). The Dmab group showed a significantly higher increase in chair rising test force compared to the BP group (vitamin D = + 5.8 ± 12.7%; BP = + 0.9 ± 8.6%; Dmab = + 8.2 ± 14.4%; Dmab vs. BP p = 0.03). Neither the changes in BMD nor in bone metabolic parameters were associated with changes in muscle performance. Conclusion Dmab resulted in increased muscle strength in the upper and lower limbs, indicating systemic rather than sitespecific effects as compared to BP. Based on these findings, Dmab might be favored over other osteoporosis treatments in patients with low BMD and poor muscle strength.

Denosumab&apos;s Therapeutic Effect for Future Osteosarcopenia Therapy : A Systematic Review and Meta-Analysis

“…Rupp et al 22 ) showed that denosumab also has better outcomes in FN BMD compared to bisphosphonate. The mean annual percentage changes in FN BMD were higher in the denosumab and bisphosphonate groups and were significantly higher compared to the basic group—mean FN BMD in % change per year: basic (-0.78%±2.12%), bisphosphonate (0.68%±2.54%), and denosumab (1.83%±2.66%).…”

Potential application of anti-osteoporotic therapy to relieve sarcopenia in the elderly

“…Current studies have shown conflicting results between anti-osteoporosis treatment and improvement of sarcopenia, with some drugs relying on a common pathway between the bone and muscle to improve sarcopenia alongside anti-osteoporosis treatment, such as denosumab and tibolone 64 , 65 . It is still unknown whether altering the ratio of cells in the skeleton without the common pathway can have an effect on muscle output, while studies on the effect of denosumab on muscle through the common pathway are very scarce, lacking control groups and considering the effect of protein intake and exercise interventions 66 .…”

Does Denosumab Really Improve Muscle Strength? Current Evidence Is Weak

“…For example, Fig. 3 illustrates a comparison of mean change in hand grip strength between denosumab users and bisphosphonate users from Miedany et al 2) and a comparison between denosumab users and no therapy from the other two studies (Bonnet et al 3) and Rupp et al 4) ). Furthermore, the Bonnet hand grip strength data in the meta-analysis are incorrect because corrected hand grip strength data published in a 2020 corrigendum 5) to the Bonnet et al 3) paper were not considered.…”