Denosumab increases sublesional bone mass in osteoporotic individuals with recent spinal cord injury

Gifre, Laia; Vidal, Joan; Carrasco, Josep L.; Muxí, África; Portell, Enric; Monegal, Ana; Guañabens, Núria; Peris, Pilar

doi:10.1007/s00198-015-3333-5

Cited by 53 publications

(38 citation statements)

References 21 publications

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“…Until adequately powered, well-designed, randomized control trials have been completed, the safety and efficacy of prescribing ZA shortly after SCI remain questionable. A recent single arm investigation looking at the effectiveness of denosumab (60 mg every 6 months) to ameliorate bone loss in 14 patients with acute SCI found this treatment was highly effective at preventing aBMD loss at the lumbar spine and total hip, but aBMD of the DF and PT was not measured, as such, the efficacy of denosumab at these ROI, and comparison to trials using ZA cannot be made at this time [118]. Given the small size of the cohorts to date and the limitations inherent when performing a bone loss intervention clinical trial shortly after SCI [e.g., corticosteroid administration, individual variation in bone loss after SCI, and limited access to advanced imaging methods (CT and/or MRI)], future randomized control trials are warranted that compare multiple anti-resorptive agents with appropriate imaging modalities to more fully understand the drug with the greatest efficacy to preserve bone mass and architecture at the knee region.…”

Section: Treatment Of Lower Extremity Bone Loss: Rehabilitation and Pmentioning

confidence: 88%

Bone loss at the distal femur and proximal tibia in persons with spinal cord injury: imaging approaches, risk of fracture, and potential treatment options

et al. 2016

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Persons with spinal cord injury (SCI) undergo immediate unloading of the skeleton and, as a result, have severe bone loss below the level of lesion associated with increased risk of long-bone fractures. The pattern of bone loss in individuals with SCI differs from other forms of secondary osteoporosis because the skeleton above the level of lesion remains unaffected, while marked bone loss occurs in the regions of neurological impairment. Striking demineralization of the trabecular epiphyses of the distal femur (supracondylar) and proximal tibia occurs, with the knee region being highly vulnerable to fracture because many accidents occur while sitting in a wheelchair, making the knee region the first point of contact to any applied force. To quantify bone mineral density (BMD) at the knee, dual energy x-ray absorptiometry (DXA) and/or computed tomography (CT) bone densitometry are routinely employed in the clinical and research settings. A detailed review of imaging methods to acquire and quantify BMD at the distal femur and proximal tibia has not been performed to date but, if available, would serve as a reference for clinicians and researchers. This article will discuss the risk of fracture at the knee in persons with SCI, imaging methods to acquire and quantify BMD at the distal femur and proximal tibia, and treatment options available for prophylaxis against or reversal of osteoporosis in individuals with SCI.

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Section: Treatment Of Lower Extremity Bone Loss: Rehabilitation and Pmentioning

confidence: 88%

Bone loss at the distal femur and proximal tibia in persons with spinal cord injury: imaging approaches, risk of fracture, and potential treatment options

et al. 2016

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“…Spinal kord hasarlı bireylerde kemik yıkımı belirteçlerini azaltmaktadır. Bu ilaç ile spinal kord hasarı ilişkili osteoporozda umut verici bir tedavi seçeneği olabilir (22). Ghermandi ve ark.…”

Section: Denosumab Genel Kullanım Endikasyonlarıunclassified

Denosumab Therapy in Giant Cell Bone Tumor: Review of Literature

Balta¹,

Kurnaz²,

Aytekin³

et al. 2017

Acta Oncol Tur.

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ÖZETDenosumab kemik dev hücreli tümörünü yönetmek için etkili ve kullanışlı bir ilaçtır. İnoperable veya metastatik dev hücreli tümörlü hastalar için birinci basamak tedavide altın standart olarak düşünülmektedir. Dev hücreli kemik tümöründe denosumabınetkinliği prospektifrandomize çalışmalarda kanıtlanmıştır. Nörovasküler yapılara yakın büyük dev hücreli tümörde daha fazla morbiditeye yol açaçak rezeksiyona yönelmek yerine denosumab ile neoadjuvan tedavi dev hücreli tümörde intralezyonel cerrahiyi kolaylaştırabilir. Farklı sebeplerden dolayı tedaviyi bıraktıktan sonra yapılan biyopside psödosarkomatöz değişiklikler görülebileceği unutulmamalıdır. Dev hücreli tümörde denosumab tedavisi sonrası kalınlaşmış korteks ve subkondral kemik içerisinde tümör hücrelerinin gizlenmesi sonucu lokal tümör rekürrensi görülebilir. Denosumab çenede osteonekroz oluşumu ile ilişkilendirilmiştir. Bu makalede denosumab tedavisi alan hastaların sistematik değerlendirilmesi,risk faktörleri, tanı-tedavi yararlığı, tedavi seçeneklerini öngören kılavuzlar sunulmuştur. Anahtar Kelimeler: denosumab, dev hücreli tümörü, cerrahi ABSTRACT Denosumab is an effective and usefull drug for managing the giant cell bonetumor. It is considered the gold standard for treatment of the inoperable or metastatic giant cell tumors. Theefficacy of denosumab in giant cell bone tumors has been demonstrated in prospective randomized trials. Neoadjuvant therapy with denosumab may facilitate intralesional surgery in giant cell tumor instead of resection leading to more morbidity in a large giant cell tumor close to the neurovascular structure. It should not be forgotten that pseudosarcomatous changes in biopsies may ocur after denosumab treatment due to different reasons. Giant cell tumor may result in dense cortex after denosumab treatment and local tumor recurrence after concealment of tumor cells within the subchondral bone. Denosumab is associated with jaw osteonecrosis formation. In this article, guidelines for systematic evaluation, risk factors, diagnostic-therapeutic usefullness and treatment options for patients treated with denosumab are presented. Keywords: denosumab, giant cell bone tumor, surgery GirişDev hücreli kemik tümörü benign fakat lokal olarak agresif davranış gösteren ve genellikle genç erişkinleri etkileyen bir lezyondur (1). Dev hücreli kemik tümöründen etkilenen hastaların % 1-4 ünde çoğu benign olmak üzere akciğer metastazı görülür (2, 3). Dev hücreli kemik tümörleri tüm primer kemik tümörlerinin % 4-5'ini ve tüm benign tümörlerin % 20'sini oluşturur. Kadınlarda 1,5-2 kat daha fazla görülür ve genellikle genç kadınları (20-40 yaş arası) etkiler (1, 4). Dev hücreli kemik tümörünün distal femur, proksimal tibia, distal radius ve proksimal humerus en sık rastlanan tutulum yeridir (5). Aksiyel iskelette en fazla sakrumda görülür (1,4,5). Kemiğin korteksini genellikle inceltir, çoğunlukla ekspanse olur. Yumuşak doku genişlemesi ile veya yumuşak doku genişlemesi olmadan kortekste lizis yapabilir (6). Anterior vertebral kolon tutulumu sıklıkla ...

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“…Although there is evidence suggesting that these drugs mitigate bone loss after SCI, they do not stimulate new bone formation. To date, there have been few therapeutic interventions shown to stimulate new bone formation, increase bone mass, improve bone microarchitecture, or improve bone strength after SCI . Bone is a dynamic organ that modulates the rate of new bone formation in response to varying levels of mechanical strain.…”

Section: Introductionmentioning

confidence: 99%

“…To date, there have been few therapeutic interventions shown to stimulate new bone formation, increase bone mass, improve bone microarchitecture, or improve bone strength after SCI. (12)(13)(14) Bone is a dynamic organ that modulates the rate of new bone formation in response to varying levels of mechanical strain. Weight-bearing exercises have been shown to increase bone density, cortical thickness, and bone strength in the general population.…”

Section: Introductionmentioning

confidence: 99%

Combination Therapy With Zoledronic Acid and FES‐Row Training Mitigates Bone Loss in Paralyzed Legs: Results of a Randomized Comparative Clinical Trial

et al. 2019

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Spinal cord injury (SCI) results in rapid, severe osteoporosis and an increased risk of lower extremity fractures. Despite the medical complications associated with these fractures, there is no standard of care to prevent osteoporotic fractures following SCI. Functional electrical stimulation‐ (FES‐) assisted rowing is a promising intervention to improve bone health in SCI because of its ability to generate a muscular contraction in conjunction with mechanical loading of the lower extremity long bones. Combination therapy consisting of FES‐rowing plus zoledronic acid (ZA) may be a superior treatment via inhibition of bone resorption and stimulation of new bone formation. We studied participants enrolled in a randomized clinical trial comparing FES‐rowing alone with FES‐rowing plus ZA to improve bone health in SCI. Volumetric CT scans at the distal femur and proximal tibial metaphyses were performed. Bone geometric properties (cortical thickness index [CTI], cortical compressive strength index [CSI], buckling ratio [BR], bending strength index) and mineral (cortical bone volume [CBV], cortical bone mineral density, cortical bone mineral content) indices were determined. In models adjusting for baseline values, we found that the CBV ( p = 0.05 to 0.006), the CTI ( p = 0.009), and the BR ( p = 0.001) at both the distal femoral and proximal tibial metaphyses were greater in the ZA plus rowing group compared with the rowing‐only group. Similarly, there was a significant positive association between the total rowing work completed and the BR at the proximal tibia ( p = 0.05). A subgroup analysis of the rowing‐only arm showed that gains in the CSI at the tibial metaphysis varied in a dose‐dependent fashion based on the total amount of exercise performed ( p = 0.009). These findings demonstrate that the osteogenic response to FES‐rowing is dose‐dependent. Combination therapy with ZA and FES‐row training has therapeutic potential to improve bone quality, and perhaps reduce fracture risk at the most common fracture site following SCI. © 2019 The Authors. JBMR Plus Published by Wiley Periodicals, Inc. on behalf of the American Society for Bone and Mineral Research.

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Denosumab increases sublesional bone mass in osteoporotic individuals with recent spinal cord injury

Abstract: Treatment with denosumab increases lumbar and femoral BMD and decreases bone turnover markers in individuals with recent SCI. This drug may be a promising therapeutic option in SCI-related osteoporosis.

Cited by 53 publications

References 21 publications

Bone loss at the distal femur and proximal tibia in persons with spinal cord injury: imaging approaches, risk of fracture, and potential treatment options

Bone loss at the distal femur and proximal tibia in persons with spinal cord injury: imaging approaches, risk of fracture, and potential treatment options

Denosumab Therapy in Giant Cell Bone Tumor: Review of Literature

Combination Therapy With Zoledronic Acid and FES‐Row Training Mitigates Bone Loss in Paralyzed Legs: Results of a Randomized Comparative Clinical Trial

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