Bone turnover rate and bone formation/resorption balance during the early stage after switching from a bone resorption inhibitor to denosumab are predictive factors of bone mineral density change

Abstract

ObjectivesThis study aimed to investigate the correlation between bone mineral density (BMD) and the turnover rate [√(MoMf2 + MoMr2), multiple of median formation (MoMf) was calculated as bone-specific alkaline phosphatase (BAP) value/18.6 and multiple of median resorption (MoMr) as tartrate-resistant acid phosphatase 5b (TRACP-5b) value/463] and the balance (MoMf/MoMr) and to compare differences in therapeutic effects evoked by differences in previous treatments.MethodsIn 51 osteoporotic women treated with bisphosphonates (BPs) or selective estrogen receptor modulators (SERMs), BMD was measured at 0, 24, and 48 weeks after denosumab administration. The values of BAP and TRACP-5b were measured at 0, 4, 12, 24, 36, and 48 weeks.ResultsThe turnover rate decreased at week 4 and decreased further at week 12. The balance indicated a relative predominantly formative state at week 4. This balance became higher in the SERM group than in the BP group at week 4. A correlation was observed between the rate of BMD change and turnover rate at weeks 0 and 4.ConclusionsIt is necessary to evaluate the turnover rate and balance to determine the therapeutic effect of denosumab, which induces dissociation between the trends in the bone turnover markers. Turnover rate and balance during the early stages of denosumab treatment may be predictive factors of BMD. When switching from bone resorption inhibitors to denosumab, it was necessary to consider the beginning values that were affected by the previous treatment. The state of relative anabolism is greater at 4 weeks when the previous treatment involved SERMs rather than BPs.

Beneficial effects of switching to denosumab from bisphosphonates or selective estrogen receptor modulators in postmenopausal women with type 2 diabetes and osteopenia/osteoporosis

“…These markers would change more sensitively than BMD within the relatively shorter 6‐month period, which was observed in the present study 25 . In a previous study, the change in bone metabolic markers from SERM to Dmab showed a greater reduction than from BP to Dmab in the study population, including non‐type 2 diabetes mellitus patients 26 . Those results were consistent with the results of the present study in the population with type 2 diabetes mellitus.…”

“…BMD increases in response to Dmab were similar between responders and non-responders to previous BP treatment 17 . It was also shown that LS and FN BMD values increased significantly at weeks 24 and 48 compared with week 0 after switching from SERM to Dmab in 19 osteoporotic women 18 . Although Dmab is effective in patients with BP-and SERM-resistant primary osteoporosis 12,17 , there have been no reports on its effects in the type 2 diabetes mellitus population or the effects of switching from SERM to Dmab.…”

Differentiating the causes of adynamic bone in advanced chronic kidney disease informs osteoporosis treatment

“…In addition, denosumab had a greater effect on BMD gain if initiated after bisphosphonate treatment than after selective oestrogen receptor modulators, in spite of a lower bone turnover at treatment initiation in the former group. 134 To our knowledge, the effect baseline bone turnover on the efficacy of denosumab in advanced CKD has yet to be determined. However, a recent study, demonstrating a positive effect of denosumab on BMD in advanced CKD, used an upper limit for PTH of 240 pg/mL, thereby increasing the probability of selecting patients with bone turnover in the lower spectrum.…”

Glucocorticoid effects on bone strength in children with renal diseases

“…The balance between bone formation and resorption may have shifted to favour formation during this period. It has been reported that BMD increased when the predominantly formative state of bone was maintained 21 . In fact, S‐TRACP‐5b levels remained low compared with those at baseline, while S‐ALP levels recovered during that period (Figure 2f).…”

“…It has been reported that BMD increased when the predominantly formative state of bone was maintained. 21 In fact, S-TRACP-5b levels remained low compared with those at baseline, while S-ALP levels recovered during that period (Figure 2f). recovered after 12 months, when STx was terminated ( Figure 2F).…”