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Kobayakawa T, Kanayama Y, Hirano Y, Nakamura Y. Comparison of Denosumab with Romosozumab in the treatment of male osteoporosis: a retrospective cohort study. Sci Rep 2024; 14:22785. [PMID: 39354026 PMCID: PMC11448481 DOI: 10.1038/s41598-024-73398-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Accepted: 09/17/2024] [Indexed: 10/03/2024] Open
Abstract
We aimed to investigate the efficacy of romosozumab treatment compared with that of denosumab in especially male osteoporosis patients. This retrospective cohort study included 174 Japanese male patients receiving either denosumab or romosozumab for 12 months. Propensity score matching extracted 50 patients per treatment group for standardization of group characteristics. The endpoints include the rate of change in the bone mineral density (BMD) of the lumbar spine, total hip, and femoral neck after 12 months of treatment as well as the changes in serum bone metabolism markers. The mean 12-month percentage increase in the lumbar spine BMD from baseline was significantly greater with romosozumab (13.0% ±1.7%) than with denosumab (4.5%±0.6%) (P < 0.01). The total hip and femoral neck BMD exhibited a similar trend at 12 months; however, no significant between-group differences were observed. With denosumab, bone formation, and resorption marker levels significantly decreased at 6 and 12 months. Conversely, with romosozumab, the levels of bone formation markers increased transiently at 6 months before returning to baseline, whereas bone resorption markers significantly decreased at both time points. Romosozumab demonstrated significantly superior effects over denosumab in improving BMD, especially of the lumbar spine, suggesting that romosozumab can be used for treating male osteoporosis.
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Affiliation(s)
- Tomonori Kobayakawa
- Kobayakawa Orthopedic and Rheumatologic Clinic, 1969 Kunou, Fukuroi, Shizuoka, 437-0061, Japan
| | - Yasuhide Kanayama
- Department of Orthopedic Surgery and Rheumatology, Toyota Kosei Hospital, 500-1 Ibobara Josui-cho, Toyota, Aichi, 470-0396, Japan
| | - Yuji Hirano
- Department of Rheumatology, Toyohashi Municipal Hospital, 50 Aza Hachiken Nishi, Aotake- Cho, Toyohashi, Aichi, 441-8570, Japan
| | - Yukio Nakamura
- Osteoporosis・Locomotive Syndrome・Joint disease Center, Asichi Medical University, 1-1 Yazakokarimata, Nagakute, 480-1195, Japan.
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Dimai HP, Muschitz C, Amrein K, Bauer R, Cejka D, Gasser RW, Gruber R, Haschka J, Hasenöhrl T, Kainberger F, Kerschan-Schindl K, Kocijan R, König J, Kroißenbrunner N, Kuchler U, Oberforcher C, Ott J, Pfeiler G, Pietschmann P, Puchwein P, Schmidt-Ilsinger A, Zwick RH, Fahrleitner-Pammer A. [Osteoporosis-Definition, risk assessment, diagnosis, prevention and treatment (update 2024) : Guidelines of the Austrian Society for Bone and Mineral Research]. Wien Klin Wochenschr 2024; 136:599-668. [PMID: 39356323 PMCID: PMC11447007 DOI: 10.1007/s00508-024-02441-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/23/2024] [Indexed: 10/03/2024]
Abstract
BACKGROUND Austria is among the countries with the highest incidence and prevalence of osteoporotic fractures worldwide. Guidelines for the prevention and management of osteoporosis were first published in 2010 under the auspices of the then Federation of Austrian Social Security Institutions and updated in 2017. The present comprehensively updated guidelines of the Austrian Society for Bone and Mineral Research are aimed at physicians of all specialties as well as decision makers and institutions in the Austrian healthcare system. The aim of these guidelines is to strengthen and improve the quality of medical care of patients with osteoporosis and osteoporotic fractures in Austria. METHODS These evidence-based recommendations were compiled taking randomized controlled trials, systematic reviews and meta-analyses as well as European and international reference guidelines published before 1 June 2023 into consideration. The grading of recommendations used ("conditional" and "strong") are based on the strength of the evidence. The evidence levels used mutual conversions of SIGN (1++ to 3) to NOGG criteria (Ia to IV). RESULTS The guidelines include all aspects associated with osteoporosis and osteoporotic fractures, such as secondary causes, prevention, diagnosis, estimation of the 10-year fracture risk using FRAX®, determination of Austria-specific FRAX®-based intervention thresholds, drug-based and non-drug-based treatment options and treatment monitoring. Recommendations for the office-based setting and decision makers and institutions in the Austrian healthcare system consider structured care models and options for osteoporosis-specific screening. CONCLUSION The guidelines present comprehensive, evidence-based information and instructions for the treatment of osteoporosis. It is expected that the quality of medical care for patients with this clinical picture will be substantially improved at all levels of the Austrian healthcare system.
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Affiliation(s)
- Hans Peter Dimai
- Klinische Abteilung für Endokrinologie und Diabetologie, Universitätsklinik für Innere Medizin, Medizinische Universität Graz, Graz, Österreich
| | - Christian Muschitz
- healthPi Medical Center, Medizinische Universität Wien, Wollzeile 1-3, 1010, Wien, Österreich.
- Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich.
| | - Karin Amrein
- Klinische Abteilung für Endokrinologie und Diabetologie, Universitätsklinik für Innere Medizin, Medizinische Universität Graz, Graz, Österreich
| | | | - Daniel Cejka
- Interne 3 - Nieren- und Hochdruckerkrankungen, Transplantationsmedizin, Rheumatologie, Ordensklinikum Linz Elisabethinen, Linz, Österreich
| | - Rudolf Wolfgang Gasser
- Universitätsklinik für Innere Medizin, Medizinische Universität Innsbruck, Innsbruck, Österreich
| | - Reinhard Gruber
- Universitätszahnklinik, Medizinische Universität Wien, Wien, Österreich
| | - Judith Haschka
- Hanusch Krankenhaus Wien, 1. Medizinische Abteilung, Ludwig Boltzmann Institut für Osteologie, Wien, Österreich
- Rheuma-Zentrum Wien-Oberlaa, Wien, Österreich
| | - Timothy Hasenöhrl
- Universitätsklinik für Physikalische Medizin, Rehabilitation und Arbeitsmedizin, Medizinische Universität Wien, Wien, Österreich
| | - Franz Kainberger
- Klinische Abteilung für Biomedizinische Bildgebung und Bildgeführte Therapie, Universitätsklinik für Radiologie und Nuklearmedizin, Medizinische Universität Wien, Wien, Österreich
| | - Katharina Kerschan-Schindl
- Universitätsklinik für Physikalische Medizin, Rehabilitation und Arbeitsmedizin, Medizinische Universität Wien, Wien, Österreich
| | - Roland Kocijan
- Hanusch Krankenhaus Wien, 1. Medizinische Abteilung, Ludwig Boltzmann Institut für Osteologie, Wien, Österreich
| | - Jürgen König
- Department für Ernährungswissenschaften, Universität Wien, Wien, Österreich
| | | | - Ulrike Kuchler
- Universitätszahnklinik, Medizinische Universität Wien, Wien, Österreich
| | | | - Johannes Ott
- Klinische Abteilung für gynäkologische Endokrinologie und Reproduktionsmedizin, Universitätsklinik für Frauenheilkunde, Medizinische Universität Wien, Wien, Österreich
| | - Georg Pfeiler
- Klinische Abteilung für Gynäkologie und Gynäkologische Onkologie, Universitätsklinik für Frauenheilkunde, Medizinische Universität Wien, Wien, Österreich
| | - Peter Pietschmann
- Institut für Pathophysiologie und Allergieforschung, Zentrum für Pathophysiologie, Infektiologie und Immunologie (CEPII), Medizinische Universität Wien, Wien, Österreich
| | - Paul Puchwein
- Universitätsklinik für Orthopädie und Traumatologie, Medizinische Universität Graz, Graz, Österreich
| | | | - Ralf Harun Zwick
- Ludwig Boltzmann Institut für Rehabilitation Research, Therme Wien Med, Wien, Österreich
| | - Astrid Fahrleitner-Pammer
- Privatordination Prof. Dr. Astrid Fahrleitner-Pammer
- Klinische Abteilung für Endokrinologie und Diabetes, Universitätsklinik für Innere Medizin, Medizinische Universität Graz, Graz, Österreich
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Ebina K, Etani Y, Noguchi T, Nakata K, Okada S. Clinical effects of teriparatide, abaloparatide, and romosozumab in postmenopausal osteoporosis. J Bone Miner Metab 2024:10.1007/s00774-024-01536-0. [PMID: 39009890 DOI: 10.1007/s00774-024-01536-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Accepted: 06/22/2024] [Indexed: 07/17/2024]
Abstract
In the management of osteoporosis, anti-resorptive agents serve as a primary therapeutic approach. However, in cases where individuals exhibit an increased susceptibility to fractures, such as those characterized by severe low bone mass or a history of vertebral or hip fractures that markedly diminish life expectancy, the immediate reduction of fracture risk through the administration of osteoanabolic agents could be beneficial. Teriparatide, available in daily, once-weekly, or twice-weekly dosages, along with abaloparatide and romosozumab, constitutes a trio of such agents. Each of these medications is defined by unique characteristics, distinct efficacy profiles, and specific adverse effects. There is growing evidence to suggest that these agents have a superior effect on enhancing bone mineral density and reducing fracture incidence when compared to traditional bisphosphonate therapies. Nonetheless, their employment demands thorough consideration of clinical indications, which includes evaluating economic factors, the frequency of injections required, and the potential for adverse effects. The objective of this review is to consolidate the current evidence focusing primarily on the efficacy of these agents, with the goal of enhancing understanding and aiding in making more informed treatment decisions, particularly for those individuals who are at an elevated risk of fractures.
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Affiliation(s)
- Kosuke Ebina
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamada-Oka, Suita, Osaka, 565-0871, Japan.
- Department of Sports Medical Biomechanics, Osaka University Graduate School of Medicine, 2-2 Yamada-Oka, Suita, Osaka, 565-0871, Japan.
| | - Yuki Etani
- Department of Sports Medical Biomechanics, Osaka University Graduate School of Medicine, 2-2 Yamada-Oka, Suita, Osaka, 565-0871, Japan
| | - Takaaki Noguchi
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamada-Oka, Suita, Osaka, 565-0871, Japan
| | - Ken Nakata
- Department of Health and Sport Sciences, Osaka University Graduate School of Medicine, 2-2 Yamada-Oka, Suita, Osaka, 565-0871, Japan
| | - Seiji Okada
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamada-Oka, Suita, Osaka, 565-0871, Japan
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Cianferotti L, Cipriani C, Palermo A, Viapiana O, Zavatta G, Mazziotti G. A practical approach for anabolic treatment of bone fragility with romosozumab. J Endocrinol Invest 2024:10.1007/s40618-024-02395-2. [PMID: 38789679 DOI: 10.1007/s40618-024-02395-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Accepted: 05/11/2024] [Indexed: 05/26/2024]
Abstract
BACKGROUND Romosozumab, a fully humanized anti-sclerostin-antibody, is a bone-builder stimulating osteoblasts and inhibiting osteoclast by activation of the canonical Wnt-beta catenin signaling. This unique mechanism of action has the potential to address unmet needs in osteoporosis management. METHODS The multifaceted practical clinical issues related to romosozumab are discussed, especially focusing on the rationale of employing a sclerostin inhibitor to target bone fragility as first line or second line treatment in post-menopausal osteoporosis and in males at increased risk of fractures. RESULTS Four randomized clinical trials with several post-hoc analyses and more than ten observational studies have consistently demonstrated that romosozumab is effective in rapidly increasing bone mineral density (BMD) and decreasing risk of vertebral, non-vertebral and hip fractures in post-menopausal women at very-high risk of fractures. In male osteoporosis, only data on BMD are available. Noteworthy, romosozumab was shown to be more effective and rapid than teriparatide in improving BMD, bone structure and strength at the hip, especially in women already treated with anti-resorptive drugs. Interestingly, even if romosozumab displays best results in treatment-naïve patients, its favourable effects on BMD were observed even in women previously treated with teriparatide or denosumab, although to a lesser extent. CONCLUSIONS Based on the available evidence, romosozumab could be proposed as ideal drug in several clinical settings, such as non-fractured post-menopausal women at very-high risk of fractures, patients with recent hip fracture, patients non responder to bisphosphonates and short-term denosumab therapy.
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Affiliation(s)
- L Cianferotti
- Bone Metabolic Diseases Unit, Department of Experimental and Clinical Biomedical Sciences, University Hospital of Florence, University of Florence, Florence, Italy
| | - C Cipriani
- Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - A Palermo
- Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
- Unit of Metabolic Bone and Thyroid Disorders, Department of Medicine, Università Campus Bio-Medico di Roma, Rome, Italy
| | - O Viapiana
- Rheumatology Section, Department of Medicine, University of Verona, Verona, Italy
| | - G Zavatta
- Division of Endocrinology and Diabetes Prevention and Care, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - G Mazziotti
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini, 420090, Pieve Emanuele, MI, Italy.
- Endocrinology, Diabetology and Andrology Unit, Osteoporosis and Bone Diseases Section, IRCCS Humanitas Research Hospital, Rozzano, MI, Italy.
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Smit A, Meijer O, Winter E. The multi-faceted nature of age-associated osteoporosis. Bone Rep 2024; 20:101750. [PMID: 38566930 PMCID: PMC10985042 DOI: 10.1016/j.bonr.2024.101750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 03/03/2024] [Accepted: 03/04/2024] [Indexed: 04/04/2024] Open
Abstract
Age-associated osteoporosis (AAOP) poses a significant health burden, characterized by increased fracture risk due to declining bone mass and strength. Effective prevention and early treatment strategies are crucial to mitigate the disease burden and the associated healthcare costs. Current therapeutic approaches effectively target the individual contributing factors to AAOP. Nonetheless, the management of AAOP is complicated by the multitude of variables that affect its development. Main intrinsic and extrinsic factors contributing to AAOP risk are reviewed here, including mechanical unloading, nutrient deficiency, hormonal disbalance, disrupted metabolism, cognitive decline, inflammation and circadian disruption. Furthermore, it is discussed how these can be targeted for prevention and treatment. Although valuable as individual targets for intervention, the interconnectedness of these risk factors result in a unique etiology for every patient. Acknowledgement of the multifaceted nature of AAOP will enable the development of more effective and sustainable management strategies, based on a holistic, patient-centered approach.
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Affiliation(s)
- A.E. Smit
- Department of Medicine, Division of Endocrinology, Leiden University Medical Center, Leiden, the Netherlands
- Einthoven Laboratory for Experimental Vascular Medicine, Leiden, the Netherlands
| | - O.C. Meijer
- Department of Medicine, Division of Endocrinology, Leiden University Medical Center, Leiden, the Netherlands
- Einthoven Laboratory for Experimental Vascular Medicine, Leiden, the Netherlands
| | - E.M. Winter
- Department of Medicine, Division of Endocrinology, Leiden University Medical Center, Leiden, the Netherlands
- Einthoven Laboratory for Experimental Vascular Medicine, Leiden, the Netherlands
- Department of Medicine, Center for Bone Quality, Leiden University Medical Center, Leiden, the Netherlands
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Ramchand SK, Leder BZ. Sequential Therapy for the Long-Term Treatment of Postmenopausal Osteoporosis. J Clin Endocrinol Metab 2024; 109:303-311. [PMID: 37610985 DOI: 10.1210/clinem/dgad496] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 08/03/2023] [Accepted: 08/21/2023] [Indexed: 08/25/2023]
Abstract
Osteoporosis is a chronic condition characterized by decreased bone mass, loss of skeletal integrity, and increased susceptibility to fracture. Drugs used to treat osteoporosis can be classified as those that block bone resorption (antiresorptive), stimulate bone formation (anabolic), or do both. While all currently approved medications reduce the risk of fragility fractures in high-risk populations, they are generally unable to fully restore bone strength in most patients with established disease. Thus, the majority of patients require disease management over many years. Unfortunately, the continuous use of a single drug has limitations, both in terms of efficacy and safety, and so sequential therapy is commonly required. Given the expanding list of pharmacological agents currently available, careful consideration needs to be given as to which drugs to use and in what sequence. This review will evaluate the differential effects of antiresorptive, bone-forming, and dual-acting drugs when used in specific sequences and will explore the current evidence favoring the initial use of bone-forming/dual-acting drugs followed by antiresorptive medications. This review will also examine the notion that long-term treatment with an antiresorptive drug may diminish the efficacy of subsequent treatment with a bone-forming/dual-acting drug. Finally, this review will explore the current evidence pertaining to the specific issue of how to best prevent the clinical ramifications of denosumab cessation.
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Affiliation(s)
- Sabashini K Ramchand
- Department of Medicine, Endocrine Unit, Massachusetts General Hospital, Harvard University, Boston, MA 02114, USA
| | - Benjamin Z Leder
- Department of Medicine, Endocrine Unit, Massachusetts General Hospital, Harvard University, Boston, MA 02114, USA
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7
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Miyauchi A, Hamaya E, Shimauchi J, Yoshinaga Y, Nishi K. Effectiveness of romosozumab in patients with osteoporosis at high fracture risk: a Japanese real-world study. J Bone Miner Metab 2024; 42:77-89. [PMID: 38086988 DOI: 10.1007/s00774-023-01477-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 10/25/2023] [Indexed: 02/10/2024]
Abstract
INTRODUCTION To describe the real-world use of romosozumab in Japan, we conducted a chart review of > 1000 Japanese patients with osteoporosis (OP) at high risk of fracture, across multiple medical institutions. MATERIALS AND METHODS Treatment-naïve and prior OP-treatment patients who received romosozumab for 12 months followed by ≥ 6 months of sequential OP treatment were included. The primary objective described the baseline demographics and clinical characteristics; secondary objectives evaluated changes in bone mineral density (BMD) and bone turnover markers in all patients and effectiveness of romosozumab in a sub-group of treatment-naïve patients using the fracture risk assessment tool (FRAX®). RESULTS Of the 1027 patients (92.4% female), 45.0% were treatment-naïve. The mean ± SD age of treatment-naïve versus prior OP-treatment patients was 76.8 ± 8.5 and 77.1 ± 8.5 years. The most frequent prior OP treatment was bisphosphonates (45.0%). Romosozumab treatment for 12 months increased BMD at the lumbar spine in all groups; the median percent change from baseline in lumbar spine BMD was higher in the treatment-naïve (13.4%) versus prior OP-treatment group (bisphosphonates [9.2%], teriparatide [11.3%], denosumab [DMAb, 4.5%]). DMAb, bisphosphonates, or teriparatide after romosozumab maintained the BMD gains at all skeletal sites at month 18 in treatment-naïve patients. Most treatment-naïve patients were at high risk of fracture, BMD increased consistently with romosozumab regardless of the baseline fracture risk assessed by FRAX. CONCLUSION This large-scale, multicenter chart review provides clinically relevant insights into the profiles of patients initiating romosozumab, effectiveness of real-world romosozumab use, and sequential therapy in Japanese patients at high risk of fracture.
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Affiliation(s)
| | - Etsuro Hamaya
- Amgen K.K., Midtown Tower 9-7-1 Akasaka, Minato-ku, Tokyo, 107-6239, Japan.
| | | | - Yoko Yoshinaga
- Amgen K.K., Midtown Tower 9-7-1 Akasaka, Minato-ku, Tokyo, 107-6239, Japan
| | - Kiyoshi Nishi
- Amgen K.K., Midtown Tower 9-7-1 Akasaka, Minato-ku, Tokyo, 107-6239, Japan
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8
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Fu Q, Bustamante-Gomez NC, Reyes-Pardo H, Gubrij I, Escalona-Vargas D, Thostenson JD, Palmieri M, Goellner JJ, Nookaew I, Barnes CL, Stambough JB, Ambrogini E, O’Brien CA. Reduced osteoprotegerin expression by osteocytes may contribute to rebound resorption after denosumab discontinuation. JCI Insight 2023; 8:e167790. [PMID: 37581932 PMCID: PMC10561722 DOI: 10.1172/jci.insight.167790] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 08/03/2023] [Indexed: 08/17/2023] Open
Abstract
Denosumab is an anti-RANKL Ab that potently suppresses bone resorption, increases bone mass, and reduces fracture risk. Discontinuation of denosumab causes rapid rebound bone resorption and bone loss, but the molecular mechanisms are unclear. We generated humanized RANKL mice and treated them with denosumab to examine the cellular and molecular conditions associated with rebound resorption. Denosumab potently suppressed both osteoclast and osteoblast numbers in cancellous bone in humanized RANKL mice. The decrease in osteoclast number was not associated with changes in osteoclast progenitors in bone marrow. Long-term, but not short-term, denosumab administration reduced osteoprotegerin (OPG) mRNA in bone. Localization of OPG expression revealed that OPG mRNA is produced by a subpopulation of osteocytes. Long-term denosumab administration reduced osteocyte OPG mRNA, suggesting that OPG expression declines as osteocytes age. Consistent with this, osteocyte expression of OPG was more prevalent near the surface of cortical bone in humans and mice. These results suggest that new osteocytes are an important source of OPG in remodeling bone and that suppression of remodeling reduces OPG abundance by reducing new osteocyte formation. The lack of new osteocytes and the OPG they produce may contribute to rebound resorption after denosumab discontinuation.
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Affiliation(s)
- Qiang Fu
- Center for Musculoskeletal Disease Research
- Division of Endocrinology and Metabolism
| | | | - Humberto Reyes-Pardo
- Center for Musculoskeletal Disease Research
- Division of Endocrinology and Metabolism
| | - Igor Gubrij
- Center for Musculoskeletal Disease Research
- Division of Endocrinology and Metabolism
| | | | | | - Michela Palmieri
- Center for Musculoskeletal Disease Research
- Division of Endocrinology and Metabolism
| | - Joseph J. Goellner
- Center for Musculoskeletal Disease Research
- Division of Endocrinology and Metabolism
| | - Intawat Nookaew
- Center for Musculoskeletal Disease Research
- Department of Biomedical Informatics, and
| | - C. Lowry Barnes
- Center for Musculoskeletal Disease Research
- Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Jeffrey B. Stambough
- Center for Musculoskeletal Disease Research
- Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Elena Ambrogini
- Center for Musculoskeletal Disease Research
- Division of Endocrinology and Metabolism
- Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
- Central Arkansas Veterans Healthcare System, Little Rock, Arkansas, USA
| | - Charles A. O’Brien
- Center for Musculoskeletal Disease Research
- Division of Endocrinology and Metabolism
- Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
- Central Arkansas Veterans Healthcare System, Little Rock, Arkansas, USA
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9
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Kashii M, Kamatani T, Nagayama Y, Miyama A, Tsuboi H, Ebina K. Baseline serum PINP level is associated with the increase in hip bone mineral density seen with Romosozumab treatment in previously untreated women with osteoporosis. Osteoporos Int 2023; 34:563-572. [PMID: 36585509 DOI: 10.1007/s00198-022-06642-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 12/12/2022] [Indexed: 01/01/2023]
Abstract
UNLABELLED Baseline serum PINP value was significantly and independently associated with the increased bone mineral density (≥ 3%) in both total hip and femoral necks by 12 months of romosozumab treatment in patients with treatment-naive postmenopausal osteoporosis. PURPOSE Some patients fail to obtain a sufficiently increased hip bone mineral density (BMD) by romosozumab (ROMO) treatment. This study aimed to investigate the prognostic factor for increased hip BMD with ROMO in patients with treatment-naive postmenopausal osteoporosis. METHODS This prospective, observational, and multicenter study included patients (n = 63: mean age, 72.6 years; T-scores of the lumbar spine [LS], - 3.3; total hip [TH], - 2.6; femoral neck [FN], - 3.3; serum type I procollagen N-terminal propeptide [PINP], 68.5 µg/L) treated by ROMO for 12 months. BMD and serum bone turnover markers were evaluated at each time point. A responder analysis was performed to assess the patient percentage, and both univariate and multivariate analyses were performed to investigate the factors associated with clinically significant increased BMD (≥ 3%) in both TH and FN. RESULTS Percentage changes of BMD from baseline in the LS, TH, and FN areas were 17.5%, 4.9%, and 4.3%, respectively. In LS, 96.8% of patients achieved ≥ 6% increased LS-BMD, although 57.1% could not achieve ≥ 3% increased BMD in either TH or FN. Multiple regression analysis revealed that only the baseline PINP value was significantly and independently associated with ≥ 3% increased BMD in both TH and FN (p = 0.019, 95% confidence interval = 1.006-1.054). The optimal cut-off PINP value was 53.7 µg/L with 54.3% sensitivity and 92.3% specificity (area under the curve = 0.752). CONCLUSIONS In a real-world setting, baseline PINP value was associated with the increased BMD of TH and FN by ROMO treatment in treatment-naive patients.
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Affiliation(s)
- Masafumi Kashii
- Department of Orthopedic Surgery, Toyonaka Municipal Hospital, 4-14-1 Shibaharacho, Toyonaka, Osaka, 560-8565, Japan
| | - Takashi Kamatani
- Department of Orthopedic Surgery, Toyonaka Municipal Hospital, 4-14-1 Shibaharacho, Toyonaka, Osaka, 560-8565, Japan
| | - Yoshio Nagayama
- Nagayama Rheumatology and Orthopaedic Clinic, 4-3-25 Hiokisounishimachi, Higashi-Ku, Sakai, 599-8114, Japan
| | - Akira Miyama
- Department of Orthopaedic Surgery, Osaka Toneyama Medical Center, 5-1-1 Toneyama, Toyonaka, Osaka, 560-8552, Japan
| | - Hideki Tsuboi
- Department of Orthopaedic Surgery, Osaka Rosai Hospital, 1179-3 Nagasonecho, Kita-Ku, Sakai, 591-8025, Japan
| | - Kosuke Ebina
- Department of Musculoskeletal Regenerative Medicine, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan.
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamada-Oka, Suita, Osaka, 565-0871, Japan.
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10
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Saito T, Mizobuchi M, Kato T, Suzuki T, Fujiwara Y, Kanamori N, Makuuchi M, Honda H. One-Year Romosozumab Treatment Followed by One-Year Denosumab Treatment for Osteoporosis in Patients on Hemodialysis: An Observational Study. Calcif Tissue Int 2023; 112:34-44. [PMID: 36287217 DOI: 10.1007/s00223-022-01031-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 10/10/2022] [Indexed: 01/07/2023]
Abstract
There is limited evidence on the use of romosozumab (ROMO) in the treatment of osteoporosis in patients on hemodialysis (HD); thus, we aimed to investigate this topic. This prospective, observational, single-center cohort study included 13 prior osteoporosis treatment-naïve patients on HD with osteoporosis. They first received ROMO once monthly for 12 months (210 mg; subcutaneously once every month). Thereafter, they received denosumab (DENO) for an additional 12 months (60 mg; subcutaneously once every 6 months). We examined the incidence of new fractures; treatment safety; and temporal changes in the bone mineral density (BMD), bone metabolism markers, and vascular calcification. No new cases of fractures were noted. The median one-year percentage changes (from the baseline) in the BMDs at the lumbar spine (LS), total hip (TH), and femoral neck (FN) were + 9.0%, + 2.5%, and + 4.7%, respectively. These changes were maintained for 24 months. The corresponding relative changes from the baseline to 24 months thereafter were + 14.9%, + 5.4%, and + 6.5%, respectively. The percentage changes in TH BMD and FN BMD were negatively correlated with baseline BMD. Coronary artery and thoracic aorta calcification scores increased slightly from baseline to 12 months thereafter. However, fatal events (cardiovascular disease-associated and all-cause deaths) did not occur during ROMO treatment. Effectiveness of ROMO was better in patients who had severe osteoporosis with low TH BMD, low FN BMD, and high tartrate-resistant acid phosphatase 5b level at ROMO initiation.
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Affiliation(s)
- Tomohiro Saito
- Division of Nephrology, Department of Medicine, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-Ku, Tokyo, 142-8555, Japan.
| | - Masahide Mizobuchi
- Division of Nephrology, Department of Medicine, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-Ku, Tokyo, 142-8555, Japan
| | - Tadashi Kato
- Division of Nephrology, Department of Medicine, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-Ku, Tokyo, 142-8555, Japan
| | - Taihei Suzuki
- Division of Nephrology, Department of Medicine, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-Ku, Tokyo, 142-8555, Japan
| | - Yasuro Fujiwara
- Sannoudai Hospital, Isioka-Si, 4-1-38 Higasiishioka, Ibaraki, 315-0037, Japan
| | - Naoaki Kanamori
- Sannoudai Hospital, Isioka-Si, 4-1-38 Higasiishioka, Ibaraki, 315-0037, Japan
| | - Mikio Makuuchi
- Sannoudai Hospital, Isioka-Si, 4-1-38 Higasiishioka, Ibaraki, 315-0037, Japan
| | - Hirokazu Honda
- Division of Nephrology, Department of Medicine, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-Ku, Tokyo, 142-8555, Japan
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11
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Kim AS, Girgis CM, McDonald MM. Osteoclast Recycling and the Rebound Phenomenon Following Denosumab Discontinuation. Curr Osteoporos Rep 2022; 20:505-515. [PMID: 36201122 PMCID: PMC9718877 DOI: 10.1007/s11914-022-00756-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/19/2022] [Indexed: 01/30/2023]
Abstract
PURPOSE OF REVIEW Inhibition of receptor activator of nuclear factor kappa-B ligand (RANKL) with denosumab is an effective treatment in a number of conditions including osteoporosis where suppression of bone resorption is desired. However, denosumab discontinuation is associated with rebound increase in bone resorption and subsequent loss in bone mass and a rapid return to baseline fracture risk. We review recent data on the rebound increase in bone resorption following denosumab discontinuation and the potential mechanisms behind this phenomenon. RECENT FINDINGS Osteoclasts have been considered to be highly specialised cells that undergo apoptosis after fulfilling their function of bone resorption. However, recent studies suggest that osteoclasts are longer lived cells which migrate through vasculature and are capable of undergoing fission into a novel cell type (the osteomorph) and re-fusion in a process termed osteoclast recycling. The life cycle of the osteoclast is more complex than previously appreciated. Osteoclast recycling provides a novel mechanistic framework to examine changes in osteoclast biology in response to treatment of bone diseases and provides an exciting new avenue towards personalised medicine.
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Affiliation(s)
- Albert S Kim
- Bone Biology Program, Garvan Institute of Medical Research, Sydney, Australia
- Faculty of Medicine UNSW Sydney, St Vincent's Clinical School, Kensington, NSW, Australia
- Department of Diabetes and Endocrinology, Westmead Hospital, Westmead, NSW, Australia
| | - Christian M Girgis
- Department of Diabetes and Endocrinology, Westmead Hospital, Westmead, NSW, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- The Westmead Institute for Medical Research, Westmead, NSW, Australia
| | - Michelle M McDonald
- Bone Biology Program, Garvan Institute of Medical Research, Sydney, Australia.
- Faculty of Medicine UNSW Sydney, St Vincent's Clinical School, Kensington, NSW, Australia.
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12
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Jeong HG, Kim MK, Lim HJ, Kim SK. Up-to-Date Knowledge on Osteoporosis Treatment Selection in Postmenopausal Women. J Menopausal Med 2022; 28:85-91. [PMID: 36647271 PMCID: PMC9843036 DOI: 10.6118/jmm.22007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 08/20/2021] [Accepted: 09/12/2021] [Indexed: 11/12/2022] Open
Abstract
The concept of a super-aged society has led to a steady increase in the average lifespan and hence, interest in a healthy life has increased. Aging is a major risk factor for many diseases, including osteoporosis. Osteoporotic fractures have a significant impact on the quality of life of the elderly and hence, it is pivotal to provide effective treatment of osteoporosis after menopause. Osteoporosis requires proper management and the treatment must be centered on long-term goals. New drugs with diverse mechanisms have been developed for treating osteoporosis. Current management of osteoporosis generally focuses on the importance of risk-based strategies to maximize the effectiveness of existing treatments and mitigate potential negative side-effects. Additionally, there is a need for sequential treatment of osteoporosis in the future. This review discusses the dynamic strategies for osteoporosis treatment and the importance of long-term management in postmenopausal women.
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Affiliation(s)
- Hye Gyeong Jeong
- Department of Obstetrics and Gynecology, Korea University Anam Hospital, Seoul, Korea.,Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
| | - Min Kyung Kim
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hee Jeung Lim
- Department of Obstetrics and Gynecology, Seoul National University Hospital, Seoul, Korea
| | - Seul Ki Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea.,Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Korea
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13
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Silva BC, Madeira M, d'Alva CB, Maeda SS, de Holanda NCP, Ohe MN, Szejnfeld V, Zerbini CAF, de Paula FJA, Bandeira F. Definition and management of very high fracture risk in women with postmenopausal osteoporosis: a position statement from the Brazilian Society of Endocrinology and Metabolism (SBEM) and the Brazilian Association of Bone Assessment and Metabolism (ABRASSO). ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2022; 66:591-603. [PMID: 36191263 PMCID: PMC10118822 DOI: 10.20945/2359-3997000000522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/22/2023]
Abstract
Several drugs are available for the treatment of osteoporosis in postmenopausal women. Over the last decades, most patients requiring pharmacological intervention were offered antiresorptive drugs as first-line therapy, while anabolic agents were considered a last resource for those with therapeutic failure. However, recent randomized trials in patients with severe osteoporosis have shown that anabolic agents reduce fractures to a greater extent than antiresorptive medications. Additionally, evidence indicates that increases in bone mineral density (BMD) are maximized when patients are treated with anabolic agents first, followed by antiresorptive therapy. This evidence is key, considering that greater increases in BMD during osteoporosis treatment are associated with a more pronounced reduction in fracture risk. Thus, international guidelines have recently proposed an individualized approach to osteoporosis treatment based on fracture risk stratification, in which the stratification risk has been refined to include a category of patients at very high risk of fracture who should be managed with anabolic agents as first-line therapy. In this document, the Brazilian Society of Endocrinology and Metabolism and the Brazilian Association of Bone Assessment and Metabolism propose the definition of very high risk of osteoporotic fracture in postmenopausal women, for whom anabolic agents should be considered as first-line therapy. This document also reviews the factors associated with increased fracture risk, trials comparing anabolic versus antiresorptive agents, efficacy of anabolic agents in patients who are treatment naïve versus those previously treated with antiresorptive agents, and safety of anabolic agents.
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Affiliation(s)
- Barbara C Silva
- Unidade de Endocrinologia, Santa Casa de Belo Horizonte, Belo Horizonte, MG, Brasil
- Unidade de Endocrinologia, Hospital Felício Rocho, Belo Horizonte, MG, Brasil
- Departamento de Medicina, Centro Universitário de Belo Horizonte (UNI-BH), Belo Horizonte, MG, Brasil,
- Member of the Sociedade Brasileira de Endocrinologia e Metabolismo (SBEM)
| | - Miguel Madeira
- Divisão de Endocrinologia e Metabolismo, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
- Member of the Sociedade Brasileira de Endocrinologia e Metabolismo (SBEM)
| | - Catarina Brasil d'Alva
- Departamento de Medicina Clínica, Universidade Federal do Ceará (UFC), Fortaleza, CE, Brasil
- Member of the Sociedade Brasileira de Endocrinologia e Metabolismo (SBEM)
| | - Sergio Setsuo Maeda
- Unidade de Endocrinologia, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
- Member of the Associação Brasileira de Avaliação Óssea e Osteometabolismo (ABRASSO)
| | - Narriane Chaves Pereira de Holanda
- Divisão de Endocrinologia e Metabolismo, Universidade Federal da Paraíba, João Pessoa, PB, Brasil
- Member of the Sociedade Brasileira de Endocrinologia e Metabolismo (SBEM)
| | - Monique Nakayama Ohe
- Unidade de Endocrinologia, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
- Member of the Sociedade Brasileira de Endocrinologia e Metabolismo (SBEM)
| | - Vera Szejnfeld
- Divisão de Reumatologia, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
- Member of the Associação Brasileira de Avaliação Óssea e Osteometabolismo (ABRASSO)
| | - Cristiano A F Zerbini
- Centro Paulista de Investigação Clínica, São Paulo, SP, Brasil
- Member of the Associação Brasileira de Avaliação Óssea e Osteometabolismo (ABRASSO)
| | - Francisco José Albuquerque de Paula
- Departamento de Clínica Médica, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
- Member of the Sociedade Brasileira de Endocrinologia e Metabolismo (SBEM)
- Member of the Associação Brasileira de Avaliação Óssea e Osteometabolismo (ABRASSO)
| | - Francisco Bandeira
- Divisão de Endocrinologia e Metabolismo, Faculdade de Medicina, Universidade de Pernambuco, Recife, PE, Brasil
- Member of the Sociedade Brasileira de Endocrinologia e Metabolismo (SBEM)
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14
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Ebina K, Etani Y, Tsuboi H, Nagayama Y, Kashii M, Miyama A, Kunugiza Y, Hirao M, Okamura G, Noguchi T, Takami K, Goshima A, Miura T, Fukuda Y, Kurihara T, Okada S, Nakata K. Impact of the duration of previous osteoporosis treatment on the effect of romosozumab in patients with postmenopausal osteoporosis. Osteoporos Int 2022; 33:2441-2443. [PMID: 36066579 DOI: 10.1007/s00198-022-06545-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 08/30/2022] [Indexed: 10/14/2022]
Affiliation(s)
- Kosuke Ebina
- Department of Musculoskeletal Regenerative Medicine, Graduate School of Medicine, Osaka University, 2-2 Yamada-oka, Suita, Osaka, 565-0871, Japan.
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka University, 2-2 Yamada-oka, Suita, Osaka, 565-0871, Japan.
| | - Yuki Etani
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka University, 2-2 Yamada-oka, Suita, Osaka, 565-0871, Japan
| | - Hideki Tsuboi
- Department of Orthopaedic Surgery, Osaka Rosai Hospital, 1179-3 Nagasone-cho, Kita-ku, Sakai, 591-8025, Japan
| | - Yoshio Nagayama
- Nagayama Rheumatology and Orthopaedic Clinic, 4-3-25 Hiokisounishi-machi, Higashi-ku, Sakai, 599-8114, Japan
| | - Masafumi Kashii
- Department of Orthopaedic Surgery, Toyonaka Municipal Hospital, 4-14-1 Shibahara-cho, Toyonaka, Osaka, 560-8565, Japan
| | - Akira Miyama
- Department of Orthopaedic Surgery, Osaka Toneyama Medical Center, 5-1-1 Toneyama, Toyonaka, Osaka, 560-8552, Japan
| | - Yasuo Kunugiza
- Department of Orthopaedic Surgery, Japan Community Health Care Organization, Hoshigaoka Medical Center, 4-8-1 Hoshigaoka, Hirakata, Osaka, 573-8511, Japan
| | - Makoto Hirao
- Department of Orthopaedic Surgery, National Hospital Organization Osaka Minami Medical Center, 2-1 Kidohigashi, Kawachinagano, Osaka, 586-8521, Japan
| | - Gensuke Okamura
- Department of Orthopaedic Surgery, Osaka Rosai Hospital, 1179-3 Nagasone-cho, Kita-ku, Sakai, 591-8025, Japan
| | - Takaaki Noguchi
- Department of Orthopaedic Surgery, National Hospital Organization Osaka Minami Medical Center, 2-1 Kidohigashi, Kawachinagano, Osaka, 586-8521, Japan
| | - Kenji Takami
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka University, 2-2 Yamada-oka, Suita, Osaka, 565-0871, Japan
| | - Atsushi Goshima
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka University, 2-2 Yamada-oka, Suita, Osaka, 565-0871, Japan
| | - Taihei Miura
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka University, 2-2 Yamada-oka, Suita, Osaka, 565-0871, Japan
| | - Yuji Fukuda
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka University, 2-2 Yamada-oka, Suita, Osaka, 565-0871, Japan
| | - Takuya Kurihara
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka University, 2-2 Yamada-oka, Suita, Osaka, 565-0871, Japan
| | - Seiji Okada
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka University, 2-2 Yamada-oka, Suita, Osaka, 565-0871, Japan
| | - Ken Nakata
- Department of Health and Sport Sciences, Graduate School of Medicine, Osaka University, 2-2 Yamada-oka, Suita, Osaka, 565-0871, Japan
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15
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Precise Construction of Injectable Bioactive Glass/Polyvinyl Alcohol Nanocomposite Hydrogels Promising to Repair the Shoulder Joint Head for Hemiarthroplasty. J CLUST SCI 2022. [DOI: 10.1007/s10876-022-02331-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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16
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Geusens P, Appelman-Dijkstra NM, Zillikens MC, Willems H, Lems WF, van den Bergh J. How to implement guidelines and models of care. Best Pract Res Clin Rheumatol 2022; 36:101759. [PMID: 35729036 DOI: 10.1016/j.berh.2022.101759] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
In subjects older than 50 years, the presence of clinical risk factors (CRFs) for fractures or a recent fracture is the cornerstone for case finding. In patients who are clinically at high short- and long-term risk of fractures (those with a recent clinical fracture or with multiple CRFs), further assessment with bone mineral density (BMD) measurement using dual-energy absorptiometry (DXA), imaging of the spine, fall risk evaluation and laboratory examination contributes to treatment decisions according to the height and modifiability of fracture risk. Treatment is available with anti-resorptive and anabolic drugs, and from the start of treatment a lifelong strategy is needed to decide about continuous, intermittent, and sequential therapy. Implementation of guidelines requires further initiatives for improving case finding, public awareness about osteoporosis and national policies on reimbursement of assessment and therapy.
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Affiliation(s)
- Piet Geusens
- Department of Rheumatology, Maastricht University, Minderbroedersberg 4-6, 6211 LK Maastricht, Netherlands.
| | - Natasha M Appelman-Dijkstra
- Department of Internal Medicine-Endocrinology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, Netherlands.
| | - M Carola Zillikens
- Department of Internal Medicine, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD, Rotterdam, Netherlands.
| | - Hanna Willems
- Department of Geriatrics, Amsterdam University Medical Center, De Boelelaan 1117 1081 HV Amsterdam, Netherlands.
| | - Willem F Lems
- Department of Rheumatology, Amsterdam University Medical Center, De Boelelaan 1117 1081 HV Amsterdam, Netherlands.
| | - Joop van den Bergh
- Department of Internal Medicine, VieCuri Medisch Cenrum, Tegelseweg 210, 5912 BL Venlo, Netherlands.
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17
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Effects of Pamidronate Disodium Combined with Calcium on BMD Values and Severity of Pain in Elderly Patients with Osteoporosis Based on Mobile Terminal Platform for Internet of Things. DISEASE MARKERS 2022; 2022:5069918. [PMID: 36016848 PMCID: PMC9398865 DOI: 10.1155/2022/5069918] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 08/05/2022] [Accepted: 08/08/2022] [Indexed: 12/04/2022]
Abstract
Objective To explore the effects of pamidronate disodium combined with calcium on BMD values and the severity of pain in elderly patients with osteoporosis based on the mobile terminal platform for the Internet of Things. Methods The data of 120 patients admitted to our hospital from January 2019 to December 2020 were retrospectively analyzed. According to the patients' condition and medication wills, they were divided into the experimental group (n = 68) and the control group (n = 52). All patients were given chronic disease management based on the mobile terminals for the Internet of Things, and they received the treatment of bisphosphonates and calcium, with the supplement of calcium at a daily dose of 1000 mg. The control group was given alendronate sodium once a week, and the experimental group was given pamidronate disodium by intravenous infusion three times a month, with the treatment cycle as 1 year. The patients' bone mineral density (BMD) values and the pain indexes were compared after treatment. Results There was no statistical difference in general information between the two groups (p > 0.05). The BMD values of the lumbar vertebrae L2-4, total hip, and femur neck at 6 months and 1 year after treatment in the experimental group were significantly higher than those in the control group (p < 0.001). The pain scores at 6 months and 1 year after treatment in the experimental group were significantly lower than those in the control group (p < 0.001). Conclusion The treatment of pamidronate disodium combined with calcium based on the mobile terminal platform for the Internet of Things can reduce the severity of pain in elderly patients with osteoporosis and improve the BMD, which has a generalization value.
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18
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Ebina K, Etani Y, Tsuboi H, Nagayama Y, Kashii M, Miyama A, Kunugiza Y, Hirao M, Okamura G, Noguchi T, Takami K, Goshima A, Miura T, Fukuda Y, Kurihara T, Okada S, Nakata K. Effects of prior osteoporosis treatment on the treatment response of romosozumab followed by denosumab in patients with postmenopausal osteoporosis. Osteoporos Int 2022; 33:1807-1813. [PMID: 35362725 DOI: 10.1007/s00198-022-06386-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 03/25/2022] [Indexed: 01/28/2023]
Abstract
UNLABELLED In patients with postmenopausal osteoporosis, prior osteoporosis treatment affected the bone mineral density increase of following treatment with 12 months of romosozumab, although it did not affect that of following treatment with 12 months of denosumab after romosozumab. PURPOSE To investigate the effects of prior osteoporosis treatment on the response to treatment with romosozumab (ROMO) followed by denosumab (DMAb) in patients with postmenopausal osteoporosis. METHODS In this prospective, observational, multicenter study, treatment-naïve patients (Naïve; n = 55) or patients previously treated with bisphosphonates (BP; n = 37), DMAb (DMAb; n = 45) or teriparatide (TPTD; n = 17) (mean age, 74.6 years; T-scores of the lumbar spine [LS] - 3.2 and total hip [TH] - 2.6) were switched to ROMO for 12 months, followed by DMAb for 12 months. Bone mineral density (BMD) and serum bone turnover markers were evaluated for 24 months. RESULTS A BMD increase was observed at 12 and 24 months in the following patients: Naïve (18.2% and 22.0%), BP (10.2% and 12.1%), DMAb (6.6% and 9.7%), and TPTD (10.8% and 15.0%) (P < 0.001 between the groups at both 12 and 24 months) in LS and Naïve (5.5% and 8.3%), BP (2.9% and 4.1%), DMAb (0.6% and 2.2%), and TPTD (4.3% and 5.4%) (P < 0.01 between the groups at 12 months and P < 0.001 at 24 months) in TH, respectively. The BMD increase in LS from 12 to 24 months was negatively associated with the levels of bone resorption marker at 24 months. Incidences of major fragility fractures for the respective groups were as follows: Naïve (5.5%), BP (16.2%), DMAb (11.1%), and TPTD (5.9%). CONCLUSIONS Previous treatment affected the BMD increase of following treatment with ROMO, although it did not affect that of following treatment with DMAb after ROMO.
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Affiliation(s)
- K Ebina
- Department of Musculoskeletal Regenerative Medicine, Osaka University, Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka, 565-0871, Japan.
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka, 565-0871, Japan.
| | - Y Etani
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka, 565-0871, Japan
| | - H Tsuboi
- Department of Orthopaedic Surgery, Osaka Rosai Hospital, 1179-3 Nagasone-cho, Kita-ku, Sakai, 591-8025, Japan
| | - Y Nagayama
- Nagayama Rheumatology and Orthopaedic Clinic, 4-3-25 Hiokisounishi-machi, Higashi-ku, Sakai, 599-8114, Japan
| | - M Kashii
- Department of Orthopaedic Surgery, Toyonaka Municipal Hospital, 4-14-1 Shibahara-cho, Toyonaka, Osaka, 560-8565, Japan
| | - A Miyama
- Department of Orthopaedic Surgery, Osaka Toneyama Medical Center, 5-1-1 Toneyama, Toyonaka, Osaka, 560-8552, Japan
| | - Y Kunugiza
- Department of Orthopaedic Surgery, Japan Community Health Care Organization, Hoshigaoka Medical Center, 4-8-1 Hoshigaoka, Hirakata, Osaka, 573-8511, Japan
| | - M Hirao
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka, 565-0871, Japan
| | - G Okamura
- Department of Orthopaedic Surgery, Osaka Rosai Hospital, 1179-3 Nagasone-cho, Kita-ku, Sakai, 591-8025, Japan
| | - T Noguchi
- Department of Orthopaedic Surgery, National Hospital Organization Osaka Minami Medical Center, 2-1 Kidohigashi, Kawachinagano, Osaka, 586-8521, Japan
| | - K Takami
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka, 565-0871, Japan
| | - A Goshima
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka, 565-0871, Japan
| | - T Miura
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka, 565-0871, Japan
| | - Y Fukuda
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka, 565-0871, Japan
| | - T Kurihara
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka, 565-0871, Japan
| | - S Okada
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka, 565-0871, Japan
| | - K Nakata
- Department of Health and Sport Sciences, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka, 565-0871, Japan
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19
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Castañeda S, Gómez-Alonso C, Graña J, Guañabens N, Muñoz-Torres M, Peris P, Naves M, Álvaro-Gracia JM. Position of the Spanish Society of Rheumatology (SER) and the Spanish Society for Bone Research and Mineral Metabolism (SEIOMM) on romosozumab. REUMATOLOGIA CLINICA 2022; 18:383-386. [PMID: 35504824 DOI: 10.1016/j.reumae.2021.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 10/14/2021] [Indexed: 06/14/2023]
Affiliation(s)
- Santos Castañeda
- Servicio de Reumatología, Hospital de La Princesa, IIS-Princesa, Universidad Autónoma de Madrid, Madrid, Spain
| | - Carlos Gómez-Alonso
- UGC de Metabolismo Óseo, Hospital Universitario Central de Asturias, ISPA, Universidad de Oviedo, Oviedo, Asturias, Spain
| | - Jenaro Graña
- Servicio de Reumatología, CHU A Coruña, A Coruña, Spain
| | - Núria Guañabens
- Servicio de Reumatología, Hospital Clínic, IDIBAPs, Universidad de Barcelona, Barcelona, Spain.
| | - Manuel Muñoz-Torres
- Departamento de Medicina, Universidad de Granada, UGC Endocrinología y Nutrición Hospital Universitario Clínico San Cecilio, IBS, Granada, Spain
| | - Pilar Peris
- Servicio de Reumatología, Hospital Clínic, IDIBAPs, Universidad de Barcelona, Barcelona, Spain
| | - Manuel Naves
- UGC de Metabolismo Óseo, Hospital Universitario Central de Asturias, ISPA, REDinREN del ISCIII, Oviedo, Asturias, Spain
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Pyatilova P, Akin C, Alvarez-Twose I, Arock M, Bonadonna P, Brockow K, Butterfield JH, Broesby-Olsen S, Carter MC, Castells M, George TI, Gotlib J, Greiner G, Gülen T, Hartmann K, Hermine O, Horny HP, Jawhar M, Lange M, Lyons JJ, Maurer M, Metcalfe DD, Nedoszytko B, Niedoszytko M, Orfao A, Reiter A, Schwaab J, Sotlar K, Sperr WR, Triggiani M, Valent P, Siebenhaar F. Refined Treatment Response Criteria for Indolent Systemic Mastocytosis Proposed by the ECNM-AIM Consortium. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2022; 10:2015-2024. [PMID: 35724950 DOI: 10.1016/j.jaip.2022.05.037] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 05/12/2022] [Accepted: 05/15/2022] [Indexed: 01/08/2023]
Abstract
Indolent systemic mastocytosis (ISM) has a favorable prognosis and normal life expectancy. However, many patients suffer from mast cell (MC) mediator-related symptoms, which significantly affect quality of life (QoL). Cutaneous, gastrointestinal, and neurological complaints, musculoskeletal pain, and the presence of skin lesions, anaphylaxis, and osteoporosis are the main symptoms and signs in ISM and must be assessed in all patients before and during treatment. Validated mastocytosis-specific patient-reported outcome measures (PROMs) should be used for this purpose. Serum tryptase and KIT D816V allele burden are recommended as secondary outcome parameters, noting that they do not reflect the severity of signs, symptoms, and related QoL impairment, but indirectly express MC burden. Changes from baseline of 90%, 60%, and 30% indicate complete response >90%, major response 60% to 90%, partial response 30% to 60%, and no response <30% to treatment. To conclude, we recommend the use of PROMs as primary outcome parameters to define treatment response in patients with ISM in clinical trials and in everyday clinical practice.
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Affiliation(s)
- Polina Pyatilova
- Institute of Allergology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany
| | - Cem Akin
- Division of Allergy and Clinical Immunology, University of Michigan, Ann Arbor, Mich
| | - Iván Alvarez-Twose
- Instituto de Estudios de Mastocitosis de Castilla La Mancha (CLMast) and CIBERONC, Hospital Virgen del Valle, Toledo, Spain
| | - Michel Arock
- Department of Hematological Biology, Pitié-Salpêtrière Hospital, Paris Sorbonne University, Paris, France
| | | | - Knut Brockow
- Department of Dermatology and Allergy Biederstein, School of Medicine, Technical University of Munich, Munich, Germany
| | | | - Sigurd Broesby-Olsen
- Mastocytosis Centre, Odense University Hospital, Odense, Denmark; Department of Dermatology and Allergy Centre, Odense University Hospital, Odense, Denmark
| | - Melody C Carter
- Mast Cell Biology Section, Laboratory of Allergic Diseases, NIAID, NIH, Bethesda, Md
| | - Mariana Castells
- Division of Allergy and Immunology, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Tracy I George
- Department of Pathology, University of Utah, Salt Lake City, Utah
| | - Jason Gotlib
- Stanford University School of Medicine/Stanford Cancer Institute, Stanford, Calif
| | - Georg Greiner
- Ludwig Boltzmann Institute for Hematology and Oncology, Medical University of Vienna, Vienna, Austria; Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria; Ihr Labor, Medical Diagnostic Laboratories, Vienna, Austria
| | - Theo Gülen
- Department of Respiratory Medicine and Allergy, Karolinska University Hospital Huddinge, Stockholm, Sweden; Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Karin Hartmann
- Division of Allergy, Department of Dermatology, University Hospital Basel and University of Basel, Basel, Switzerland; Department of Biomedicine, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Olivier Hermine
- Imagine Institute Université de Paris, Sorbonne, INSERM U1163, Centre national de référence des mastocytoses, Hôpital Necker, Assistance publique hôpitaux de Paris, Paris, France
| | - Hans-Peter Horny
- Institute of Pathology, Ludwig Maximilians University, Munich, Germany
| | - Mohamed Jawhar
- Department of Hematology and Oncology, University Hospital Mannheim, Mannheim, Germany
| | - Magdalena Lange
- Department of Dermatology, Venereology and Allergology, Medical University of Gdansk, Gdansk, Poland
| | - Jonathan J Lyons
- Translational Allergic Immunopathology Unit, Laboratory of Allergic Diseases, NIAID, NIH, Bethesda, Md
| | - Marcus Maurer
- Institute of Allergology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany
| | - Dean D Metcalfe
- Mast Cell Biology Section, Laboratory of Allergic Diseases, NIAID, NIH, Bethesda, Md
| | - Boguslaw Nedoszytko
- Department of Dermatology, Venereology and Allergology, Medical University of Gdansk, Gdansk, Poland; Invicta Fertility and Reproductive Centre, Molecular Laboratory, Gdansk, Poland
| | - Marek Niedoszytko
- Department of Allergology, Medical University of Gdańsk, Gdansk, Poland
| | - Alberto Orfao
- Servicio General de Citometria, Centro de Investigacion del Cancer (IBMCC CSIC/USAL) Instituto Biosanitario de Salamanca (IBSAL), CIBERONC and Department of Medicine, University of Salamanca, Salamanca, Spain
| | - Andreas Reiter
- Institute of Pathology, Ludwig Maximilians University, Munich, Germany
| | - Juliana Schwaab
- Institute of Pathology, Ludwig Maximilians University, Munich, Germany
| | - Karl Sotlar
- Institute of Pathology, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Wolfgang R Sperr
- Ludwig Boltzmann Institute for Hematology and Oncology, Medical University of Vienna, Vienna, Austria; Department of Internal Medicine I, Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria
| | - Massimo Triggiani
- Division of Allergy and Clinical Immunology, University of Salerno, Salerno, Italy
| | - Peter Valent
- Ludwig Boltzmann Institute for Hematology and Oncology, Medical University of Vienna, Vienna, Austria; Department of Internal Medicine I, Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria
| | - Frank Siebenhaar
- Institute of Allergology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany.
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Cosman F, Kendler DL, Langdahl BL, Leder BZ, Lewiecki EM, Miyauchi A, Rojeski M, McDermott M, Oates MK, Milmont CE, Libanati C, Ferrari S. Romosozumab and antiresorptive treatment: the importance of treatment sequence. Osteoporos Int 2022; 33:1243-1256. [PMID: 35165774 PMCID: PMC9106644 DOI: 10.1007/s00198-021-06174-0] [Citation(s) in RCA: 38] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 09/23/2021] [Indexed: 12/05/2022]
Abstract
UNLABELLED To evaluate whether treatment sequence affects romosozumab response, this analysis reviewed studies where romosozumab was administered before or following an antiresorptive (alendronate or denosumab). Initial treatment with romosozumab followed by an antiresorptive resulted in larger increases in bone mineral density of both hip and spine compared with the reverse sequence. INTRODUCTION Teriparatide followed by an antiresorptive increases bone mineral density (BMD) more than using an antiresorptive first. To evaluate whether treatment sequence affects romosozumab response, we reviewed randomized clinical trials where romosozumab was administered before (ARCH, FRAME) or following (STRUCTURE, Phase 2 extension) an antiresorptive (alendronate or denosumab, respectively). METHODS We evaluated BMD percentage change for total hip (TH) and lumbar spine (LS) and response rates (BMD gains ≥ 3% and ≥ 6%) at years 1 and 2 (except STRUCTURE with only 1-year data available). RESULTS With 1-year romosozumab initial therapy in ARCH and FRAME, TH BMD increased 6.2% and 6.0%, and LS BMD increased 13.7% and 13.1%, respectively. When romosozumab was administered for 1 year after alendronate (STRUCTURE) or denosumab (Phase 2 extension), TH BMD increased 2.9% and 0.9%, respectively, and LS BMD increased 9.8% and 5.3%, respectively. Over 2 years, TH and LS BMD increased 7.1% and 15.2% with romosozumab/alendronate, 8.5% and 16.6% with romosozumab/denosumab, and 3.8% and 11.5% with denosumab/romosozumab, respectively. A greater proportion of patients achieved BMD gains ≥ 6% when romosozumab was used first, particularly for TH, versus the reverse sequence (69% after romosozumab/denosumab; 15% after denosumab/romosozumab). CONCLUSION In this study, larger mean BMD increases and greater BMD responder rates were achieved when romosozumab was used before, versus after, an antiresorptive agent. Since BMD on treatment is a strong surrogate for bone strength and fracture risk, this analysis supports the thesis that initial treatment with romosozumab followed by an antiresorptive will result in greater efficacy versus the reverse sequence.
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Affiliation(s)
- Felicia Cosman
- College of Physicians and Surgeons, Columbia University, 630 W 168th St, New York, NY, 10032, USA.
| | | | | | - Benjamin Z Leder
- Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - E Michael Lewiecki
- New Mexico Clinical Research & Osteoporosis Center, Albuquerque, NM, USA
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22
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Tominaga A, Wada K, Okazaki K, Nishi H, Terayama Y, Kodama Y, Kato Y. Effect of the duration of previous osteoporosis treatment on the effect of romosozumab treatment. Osteoporos Int 2022; 33:1265-1273. [PMID: 35059774 DOI: 10.1007/s00198-021-06261-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 12/02/2021] [Indexed: 01/19/2023]
Abstract
UNLABELLED The effect of romosozumab is affected by previous osteoporosis treatment. Here we showed that the duration of the previous treatment just before romosozumab affects the therapeutic effect of romosozumab. Using denosumab and oral bisphosphonates for more than 1 year attenuates the effect of romosozumab. INTRODUCTION As an anti-sclerostin antibody, romosozumab suppresses bone resorption and stimulates bone formation. We investigated whether the effectiveness of 12 months of romosozumab treatment depended on the duration of previous treatment with teriparatide, denosumab, or oral bisphosphonates. METHODS In total, 259 osteoporosis patients received subcutaneous injections of romosozumab (210 mg) every 4 weeks during 2019 and 2020. This study was designed as a pre-post comparison. The end points were the percent changes of bone mineral density (BMD) after 12 months of romosozumab treatment. The patients were divided into seven groups depending on the type and duration of previous treatment before starting romosozumab as follows: non-previous treatment group, change from teriparatide used for 1 year or less/more than 1 year, change from denosumab used for 1 year or less/more than 1 year, and change from oral bisphosphonates used for 1 year or less/more than 1 year. RESULTS The effects of previous treatment with teriparatide on the effectiveness of 12-month romosozumab did not clearly depend on the duration of treatment (p > 0.05). In contrast, the effects of previous treatments with denosumab or oral bisphosphonates on the effectiveness of 12-month romosozumab depended on the previous treatment duration, which was reflected by the differences in percent change of the spine BMD (both p < 0.05), however, there were no significant differences in the percent change of the total hip BMD (both p > 0.05). CONCLUSION The duration of the previous treatment affected the effectiveness of romosozumab. Using denosumab and oral bisphosphonate for more than 1 year attenuated the effect of romosozumab.
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Affiliation(s)
- A Tominaga
- Department of Orthopedic Surgery, Tokyo Women's Medical University, 8-1 Kawadacho Shinjuku-ku, Tokyo, Japan
| | - K Wada
- Department of Orthopedic Surgery, Tokyo Women's Medical University, 8-1 Kawadacho Shinjuku-ku, Tokyo, Japan.
| | - K Okazaki
- Department of Orthopedic Surgery, Tokyo Women's Medical University, 8-1 Kawadacho Shinjuku-ku, Tokyo, Japan
| | - H Nishi
- Hasuda Hospital, 1662-1 Negane Hasudashi, Saitama, Japan
| | - Y Terayama
- Hasuda Hospital, 1662-1 Negane Hasudashi, Saitama, Japan
| | - Y Kodama
- Ohara Clinic, 2-23-19 Ohara Setagaya-ku, Tokyo, Japan
| | - Y Kato
- Kita Shinagawa 3rd Hospital, 3-3-7 Kitashinagawa Shinagawa-ku, Tokyo, Japan
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Li H, Gou Y, Tian F, Lian Q, Hu Y, Zhang L. The combined anti-osteoporotic effects of simvastatin and exercise in ovariectomized mice fed a high-fat diet. Exp Gerontol 2022; 164:111794. [PMID: 35421557 DOI: 10.1016/j.exger.2022.111794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 03/13/2022] [Accepted: 03/29/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND To evaluate and compare the effects of the combined intervention of simvastatin and exercise on the bone degeneration in a mice model of osteoporosis (OP) induced by obesity and estrogen deficiency. METHODS 56 female 3-month-old C57BL/6 mice were given a standard diet or a high-fat diet after ovariectomy (OVX) or sham surgery. Drug administration and exercise training were initiated 72 h after surgical operation, which were treated with simvastatin (10 mg/kg/day) or exercise (15 m/min for 30 min/day) or combined with simvastatin and exercise at 72 h for 8 weeks. The pathology of OP was assessed by histomorphology analyses, immunohistochemistry (IHC), micro-computed tomography (Micro-CT), enzyme-linked immunosorbent assay (ELISA) and cell culture. RESULTS The coexistence of obesity and estrogen deficiency significantly further exacerbated OP pathology, and combined intervention showed a better significant anti-osteoporosis effect than monotherapy. In details, simvastatin combined with exercise ameliorated the abnormal bone mass, microstructure and bone marrow adipocyte differentiation, significantly increased osteoprotegerin (OPG), type 1 collagen (Col-I), RUNX2 and osteocalcin (OCN) expression, decreased the expression of receptor activator of nuclear factor-kappaB ligand (RANKL) and peroxisome proliferator-activated receptor γ (PPARγ). Furthermore, combined intervention markedly improved abnormal metabolic status, reduced the levels of serum glucose, insulin, triglycerides (TG), low-density lipoprotein (LDL), leptin, CTX-1 and IL-1β, and increased the level of OCN. CONCLUSIONS The coexistence of obesity and estrogen deficiency further aggravates bone tissue degeneration and abnormal metabolic pathology, which could be better inhibited by the combination with simvastatin and exercise instead of single intervention, suggesting that combined intervention may be a potential candidate for amelioration of the progression of OP.
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Affiliation(s)
- Hetong Li
- Department of Orthopedic Surgery, Hebei Medical University, Shijiazhuang, Hebei, PR China
| | - Yu Gou
- Department of Orthopaedic Surgery, Tianjin Hospital, Tianjin University, Tianjin, PR China
| | - Faming Tian
- School of Public Health, North China University of Science and Technology, Tangshan, Hebei, PR China
| | - Qiangqiang Lian
- School of Public Health, North China University of Science and Technology, Tangshan, Hebei, PR China
| | - Yunpeng Hu
- Department of Orthopedic Surgery, Hebei Medical University, Shijiazhuang, Hebei, PR China
| | - Liu Zhang
- Department of Orthopedic Surgery, Hebei Medical University, Shijiazhuang, Hebei, PR China.
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Gregson CL, Armstrong DJ, Bowden J, Cooper C, Edwards J, Gittoes NJL, Harvey N, Kanis J, Leyland S, Low R, McCloskey E, Moss K, Parker J, Paskins Z, Poole K, Reid DM, Stone M, Thomson J, Vine N, Compston J. UK clinical guideline for the prevention and treatment of osteoporosis. Arch Osteoporos 2022; 17:58. [PMID: 35378630 PMCID: PMC8979902 DOI: 10.1007/s11657-022-01061-5] [Citation(s) in RCA: 163] [Impact Index Per Article: 81.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 01/03/2022] [Indexed: 02/03/2023]
Abstract
The National Osteoporosis Guideline Group (NOGG) has revised the UK guideline for the assessment and management of osteoporosis and the prevention of fragility fractures in postmenopausal women, and men age 50 years and older. Accredited by NICE, this guideline is relevant for all healthcare professionals involved in osteoporosis management. INTRODUCTION The UK National Osteoporosis Guideline Group (NOGG) first produced a guideline on the prevention and treatment of osteoporosis in 2008, with updates in 2013 and 2017. This paper presents a major update of the guideline, the scope of which is to review the assessment and management of osteoporosis and the prevention of fragility fractures in postmenopausal women, and men age 50 years and older. METHODS Where available, systematic reviews, meta-analyses and randomised controlled trials were used to provide the evidence base. Conclusions and recommendations were systematically graded according to the strength of the available evidence. RESULTS Review of the evidence and recommendations are provided for the diagnosis of osteoporosis, fracture-risk assessment and intervention thresholds, management of vertebral fractures, non-pharmacological and pharmacological treatments, including duration and monitoring of anti-resorptive therapy, glucocorticoid-induced osteoporosis, and models of care for fracture prevention. Recommendations are made for training; service leads and commissioners of healthcare; and for review criteria for audit and quality improvement. CONCLUSION The guideline, which has received accreditation from the National Institute of Health and Care Excellence (NICE), provides a comprehensive overview of the assessment and management of osteoporosis for all healthcare professionals involved in its management. This position paper has been endorsed by the International Osteoporosis Foundation and by the European Society for the Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases.
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Affiliation(s)
- Celia L Gregson
- Musculoskeletal Research Unit, Bristol Medical School, Learning and Research Building, University of Bristol, Southmead Hospital, Bristol, BS10 5NB, UK.
- Royal United Hospital NHS Foundation Trust, Bath, UK.
| | - David J Armstrong
- Western Health and Social Care Trust (NI), Nutrition Innovation Centre for Food and Health, Ulster University, and Visiting Professor, Belfast, Northern Ireland
| | - Jean Bowden
- Musculoskeletal Research Unit, Bristol Medical School, Learning and Research Building, University of Bristol, Southmead Hospital, Bristol, BS10 5NB, UK
| | - Cyrus Cooper
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
- NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
| | - John Edwards
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Staffordshire, and Wolstanton Medical Centre, Newcastle under Lyme, UK
| | - Neil J L Gittoes
- Centre for Endocrinology, Diabetes and Metabolism, Queen Elizabeth Hospital, University Hospitals Birmingham & University of Birmingham, Birmingham, UK
| | - Nicholas Harvey
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - John Kanis
- Mary McKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia and Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK
| | | | - Rebecca Low
- Abingdon and Specialty Doctor in Metabolic Bone Disease, Marcham Road Health Centre, Nuffield Orthopaedic Centre, Oxford, UK
| | - Eugene McCloskey
- Department of Oncology & Metabolism, MRC Versus Arthritis Centre for Integrated Research in Musculoskeletal Ageing (CIMA), Mellanby Centre for Musculoskeletal Research, University of Sheffield, Sheffield, UK
| | - Katie Moss
- St George's University Hospital, London, UK
| | - Jane Parker
- Musculoskeletal Research Unit, Bristol Medical School, Learning and Research Building, University of Bristol, Southmead Hospital, Bristol, BS10 5NB, UK
| | - Zoe Paskins
- School of Medicine, Keele University, Keele, Haywood Academic Rheumatology Centre, Haywood Hospital, Midlands Partnership NHS Foundation Trust, Stoke-on-Trent, UK
| | - Kenneth Poole
- Department of Medicine, University of Cambridge, Cambridge, UK
- NIHR Cambridge Biomedical Research Centre, Cambridge, UK
| | | | - Mike Stone
- University Hospital Llandough, Cardiff and Vale University Health Board, Llandough, UK
| | | | - Nic Vine
- Musculoskeletal Research Unit, Bristol Medical School, Learning and Research Building, University of Bristol, Southmead Hospital, Bristol, BS10 5NB, UK
| | - Juliet Compston
- University of Cambridge, School of Clinical Medicine, Cambridge, UK
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Kobayakawa T, Miyazaki A, Takahashi J, Nakamura Y. Effects of Romosozumab with and without Active Vitamin D Analog Supplementation for Postmenopausal Osteoporosis. Clin Nutr ESPEN 2022; 48:267-274. [DOI: 10.1016/j.clnesp.2022.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 01/14/2022] [Accepted: 02/04/2022] [Indexed: 11/29/2022]
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Botor M, Fus-Kujawa A, Uroczynska M, Stepien KL, Galicka A, Gawron K, Sieron AL. Osteogenesis Imperfecta: Current and Prospective Therapies. Biomolecules 2021; 11:biom11101493. [PMID: 34680126 PMCID: PMC8533546 DOI: 10.3390/biom11101493] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 10/04/2021] [Accepted: 10/06/2021] [Indexed: 12/20/2022] Open
Abstract
Osteogenesis Imperfecta (OI) is a group of connective tissue disorders with a broad range of phenotypes characterized primarily by bone fragility. The prevalence of OI ranges from about 1:15,000 to 1:20,000 births. Five types of the disease are commonly distinguished, ranging from a mild (type I) to a lethal one (type II). Types III and IV are severe forms allowing survival after the neonatal period, while type V is characterized by a mild to moderate phenotype with calcification of interosseous membranes. In most cases, there is a reduction in the production of normal type I collagen (col I) or the synthesis of abnormal collagen as a result of mutations in col I genes. Moreover, mutations in genes involved in col I synthesis and processing as well as in osteoblast differentiation have been reported. The currently available treatments try to prevent fractures, control symptoms and increase bone mass. Commonly used medications in OI treatment are bisphosphonates, Denosumab, synthetic parathyroid hormone and growth hormone for children therapy. The main disadvantages of these therapies are their relatively weak effectiveness, lack of effects in some patients or cytotoxic side effects. Experimental approaches, particularly those based on stem cell transplantation and genetic engineering, seem to be promising to improve the therapeutic effects of OI.
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Affiliation(s)
- Malwina Botor
- Department of Molecular Biology and Genetics, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Medykow 18, 40-752 Katowice, Poland; (A.F.-K.); (M.U.); (K.L.S.); (K.G.); (A.L.S.)
- Correspondence:
| | - Agnieszka Fus-Kujawa
- Department of Molecular Biology and Genetics, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Medykow 18, 40-752 Katowice, Poland; (A.F.-K.); (M.U.); (K.L.S.); (K.G.); (A.L.S.)
| | - Marta Uroczynska
- Department of Molecular Biology and Genetics, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Medykow 18, 40-752 Katowice, Poland; (A.F.-K.); (M.U.); (K.L.S.); (K.G.); (A.L.S.)
| | - Karolina L. Stepien
- Department of Molecular Biology and Genetics, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Medykow 18, 40-752 Katowice, Poland; (A.F.-K.); (M.U.); (K.L.S.); (K.G.); (A.L.S.)
| | - Anna Galicka
- Department of Medical Chemistry, Medical University of Bialystok, Mickiewicza 2A, 15-222 Bialystok, Poland;
| | - Katarzyna Gawron
- Department of Molecular Biology and Genetics, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Medykow 18, 40-752 Katowice, Poland; (A.F.-K.); (M.U.); (K.L.S.); (K.G.); (A.L.S.)
| | - Aleksander L. Sieron
- Department of Molecular Biology and Genetics, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Medykow 18, 40-752 Katowice, Poland; (A.F.-K.); (M.U.); (K.L.S.); (K.G.); (A.L.S.)
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Tominaga A, Wada K, Okazaki K, Nishi H, Terayama Y, Kato Y. Early clinical effects, safety, and predictors of the effects of romosozumab treatment in osteoporosis patients: one-year study. Osteoporos Int 2021; 32:1999-2009. [PMID: 33770201 PMCID: PMC7996128 DOI: 10.1007/s00198-021-05925-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 03/11/2021] [Indexed: 01/06/2023]
Abstract
UNLABELLED Romosozumab is an effective treatment for spine osteoporosis because it reduces the incidence of new fractures and significantly increases the percent change in the spine BMD at 12 months. The percent change in the spine BMD is higher in patients not previously treated with other anti-osteoporosis medications. INTRODUCTION Romosozumab appeared as a new osteoporosis medication in Japan in 2019. It is an anti-sclerostin antibody, which increases bone formation and suppresses bone resorption. The aim of our study was to elucidate the clinical effects, safety, and predictors of the effects of one-year romosozumab treatment. METHODS This study was an observational study designed as a pre-post study in 262 patients. Romosozumab (210 mg) was administered subcutaneously once every 4 weeks during 12 months. We focused on incidence of new fractures, safety, bone mineral density (BMD) at the spine and total hip, and bone metabolism markers. RESULTS There were five cases of new fractures during one-year romosozumab treatment. There were no fatal adverse events. Percent changes from baseline in the spine and total hip BMD after 12 months of romosozumab treatment were 10.67% and 2.04%, respectively. Romosozumab had better effects in cases of severe osteoporosis with low spine BMD, high TRACP-5b, and high iP1NP at the start of romosozumab treatment. The percent change in the spine BMD at 12 months was significantly lower in the group transitioning from bisphosphonates than in the group not previously treated with other anti-osteoporosis medications. CONCLUSION Romosozumab is an effective treatment for spine osteoporosis because it significantly increases the percent change in the spine BMD at 12 months. The percent change in the spine BMD is higher in patients not previously treated with other anti-osteoporosis medications.
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Affiliation(s)
- A Tominaga
- Department of Orthopedic Surgery, Tokyo Women's Medical University, 8-1 Kawadacho Shinjuku-ku, Tokyo, Japan
| | - K Wada
- Department of Orthopedic Surgery, Tokyo Women's Medical University, 8-1 Kawadacho Shinjuku-ku, Tokyo, Japan.
| | - K Okazaki
- Department of Orthopedic Surgery, Tokyo Women's Medical University, 8-1 Kawadacho Shinjuku-ku, Tokyo, Japan
| | - H Nishi
- Hasuda Hospital, 1662-1 Negane Hasudashi, Saitama, Japan
| | - Y Terayama
- Hasuda Hospital, 1662-1 Negane Hasudashi, Saitama, Japan
| | - Y Kato
- Kita Shinagawa 3rd Hospital, 3-3-7 Kitashinagawa Shinagawa-ku, Tokyo, Japan
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Shimizu T, Arita K, Murota E, Hiratsuka S, Fujita R, Ishizu H, Asano T, Takahashi D, Takahata M, Iwasaki N. Effects after starting or switching from bisphosphonate to romosozumab or denosumab in Japanese postmenopausal patients. J Bone Miner Metab 2021; 39:868-875. [PMID: 33847831 PMCID: PMC8042469 DOI: 10.1007/s00774-021-01226-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 03/23/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE We aimed to investigate the longitudinal changes in bone metabolic markers and bone mineral density (BMD) after starting or switching from bisphosphonate (BP) to romosozumab (ROMO) or denosumab (DENO) therapies over 12 months and to determine predictors that establish associations with changes in BMD among the patients received the ROMO therapy. METHODS Postmenopausal osteoporosis patients with a high risk of fracture-154 in total-were recruited; their therapies were switched to ROMO or DENO from BP/naïve or vitamin D (ND) (ND-ROMO: 43, BP-ROMO: 38, ND-DENO: 38, and BP-DENO: 35). Longitudinal changes in bone metabolic markers and BMD were evaluated. RESULTS ROMO groups showed significant increases in BMD of the lumbar spine at 6 and 12 months and femoral neck at 12 months compared to the DENO groups. Although BP-ROMO showed significant increase in the lumbar spine BMD compared to BP-DENO, there were no significant differences in femoral neck and total hip BMDs between BP-ROMO and BP-DENO. Among the ROMO groups, % changes of BMD from baseline to 12 months were associated with bone metabolic markers at baseline and changes in TRACP-5b from baseline to 3 months. CONCLUSIONS ROMO continuously increased BMD for 12 months and performed better than DENO. On the other hand, effects of ROMO switched from BP on BMD of femoral neck and total hip were almost same with DENO. Bone metabolic markers at baseline and changes in TRACP-5b from baseline to 3 months may predict the efficacy of ROMO after 12 months of administration.
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Affiliation(s)
- Tomohiro Shimizu
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-15 Nishi-7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan.
| | - Kosuke Arita
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-15 Nishi-7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
| | - Eihiro Murota
- Department of Orthopaedic Surgery, Wajyokai Sapporo Hospital, Sapporo, Japan
| | - Shigeto Hiratsuka
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-15 Nishi-7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
- Department of Orthopaedic Surgery, Wajyokai Sapporo Hospital, Sapporo, Japan
| | - Ryo Fujita
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-15 Nishi-7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
- Department of Orthopaedic Surgery, Hokkaido Orthopaedic Memorial Hospital, Sapporo, Japan
| | - Hotaka Ishizu
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-15 Nishi-7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
| | - Tsuyoshi Asano
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-15 Nishi-7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
| | - Daisuke Takahashi
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-15 Nishi-7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
| | - Masahiko Takahata
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-15 Nishi-7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
| | - Norimasa Iwasaki
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-15 Nishi-7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
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Ishizu H, Arita K, Terkawi MA, Shimizu T, Iwasaki N. Risks vs. benefits of switching therapy in patients with postmenopausal osteoporosis. Expert Rev Endocrinol Metab 2021; 16:217-228. [PMID: 34310233 DOI: 10.1080/17446651.2021.1956902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 07/14/2021] [Indexed: 10/20/2022]
Abstract
Introduction: Osteoporosis is characterized by the fragility of bones, leading to fractures and, consequently, the deterioration of functional capacity and quality of life. Postmenopausal women, in particular, are prone to osteoporosis and often require anti-osteoporosis treatment. In the last few decades, various anti-osteoporosis drugs have been approved for clinical use. In an aging society, osteoporosis cannot be treated using a single agent; therefore, switching therapy is an important treatment strategy.Areas covered: This review covers switching therapy in patients with postmenopausal osteoporosis. It's extremely important to understand the characteristics of each drug including; limitations on the duration of use, side effects due to long-term use (such as atypical femur fracture and osteonecrosis of the jaw) or discontinuation (such as rebound phenomenon), compliance, and ability to prevent fractures. We review and summarize the risks and benefits of switching therapy.Expert opinion: When switching therapy, the order of drug administration is important. Routine monitoring should be continued after switching treatments. We recommend first using osteoanabolic agents in postmenopausal women with severe osteoporosis. In addition, identifying predictors of the efficacy and side effects of treatment may help prevent the inappropriate use of drugs for the treatment of osteoporosis.
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Affiliation(s)
- Hotaka Ishizu
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-ku, Sapporo, Japan
| | - Kosuke Arita
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-ku, Sapporo, Japan
| | - Mohamad Alaa Terkawi
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-ku, Sapporo, Japan
| | - Tomohiro Shimizu
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-ku, Sapporo, Japan
| | - Norimasa Iwasaki
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-ku, Sapporo, Japan
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Kobayakawa T, Miyazaki A, Saito M, Suzuki T, Takahashi J, Nakamura Y. Denosumab versus romosozumab for postmenopausal osteoporosis treatment. Sci Rep 2021; 11:11801. [PMID: 34083636 PMCID: PMC8175428 DOI: 10.1038/s41598-021-91248-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 05/17/2021] [Indexed: 01/22/2023] Open
Abstract
Denosumab and romosozumab, a recently approved new drug, are effective and widely known molecular-targeted drugs for postmenopausal osteoporosis treatment. However, no studies have directly compared their therapeutic effects or safety in postmenopausal osteoporosis. This retrospective observational registry study compared the efficacy of 12-month denosumab or romosozumab treatment in postmenopausal osteoporosis patients. The primary outcome was the change in bone mineral density (BMD) at the lumbar spine. Secondary outcomes included BMD changes at the total hip and femoral neck, changes in bone turnover markers, and adverse events. Propensity score matching was employed to assemble patient groups with similar baseline characteristics. Sixty-nine patients each received either denosumab or romosozumab for 12 months. The mean 12-month percentage change from baseline in lumbar spine BMD was 7.2% in the denosumab group and 12.5% in the romosozumab group, indicating a significant difference between the groups. The percentage changes in BMD at both the total hip and femoral neck were also significantly higher at 12 months in the romosozumab group than in the denosumab group. In denosumab patients, bone formation and bone resorption markers were significantly decreased at 6 and 12 months from baseline. In the romosozumab group, the bone formation marker was significantly increased at 6 months and then returned to baseline, while the bone resorption marker was significantly decreased at both time points. Adverse events were few and predominantly minor in both groups, with no remarkable difference in the incidence of new vertebral fractures. Romosozumab showed a higher potential for improving BMD than denosumab in this clinical study of postmenopausal osteoporosis patient treatment.
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Affiliation(s)
- Tomonori Kobayakawa
- Kobayakawa Orthopedic and Rheumatologic Clinic, 1969 Kunou, Fukuroi, Shizuoka, 437-0061, Japan
| | - Akiko Miyazaki
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Makoto Saito
- Department of Clinical Support Office, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, 3-18-22 Honkagome, Bunkyou-ku, Tokyo, 113-8677, Japan
| | - Takako Suzuki
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan.,Department of Human Nutrition, Faculty of Human Nutrition, Tokyo Kasei Gakuin University, 22 Sanban-cho, Chiyoda-ku, Tokyo, 102-8341, Japan
| | - Jun Takahashi
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Yukio Nakamura
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan.
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McClung MR, Bolognese MA, Brown JP, Reginster JY, Langdahl BL, Shi Y, Timoshanko J, Libanati C, Chines A, Oates MK. Skeletal responses to romosozumab after 12 months of denosumab. JBMR Plus 2021; 5:e10512. [PMID: 34258507 PMCID: PMC8260819 DOI: 10.1002/jbm4.10512] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 04/23/2021] [Accepted: 05/09/2021] [Indexed: 01/07/2023] Open
Abstract
Romosozumab, a monoclonal anti‐sclerostin antibody that has the dual effect of increasing bone formation and decreasing bone resorption, reduces fracture risk within 12 months. In a post hoc, exploratory analysis, we evaluated the effects of romosozumab after 12 months of denosumab in postmenopausal women with low bone mass who had not received previous osteoporosis therapy. This phase 2 trial (NCT00896532) enrolled postmenopausal women with a lumbar spine, total hip, or femoral neck T‐score ≤ −2.0 and ≥ −3.5. Individuals were randomized to placebo or various romosozumab dosing regimens from baseline to month 24, were re‐randomized to 12 months of denosumab or placebo (months 24–36), and then all received romosozumab 210 mg monthly for 12 months (months 36–48). Results for the overall population have been previously published. Here, we present results for changes in bone mineral density (BMD) and levels of procollagen type I N‐terminal propeptide (P1NP) and β‐isomer of the C‐terminal telopeptide of type I collagen (β‐CTX) from a subset of women who were randomized to placebo for 24 months, were re‐randomized to receive denosumab (n = 16) or placebo (n = 12) for 12 months, and then received romosozumab for 12 months. In women who were randomized to placebo followed by denosumab, romosozumab treatment for 12 months maintained BMD gained during denosumab treatment at the total hip (mean change from end of denosumab treatment of 0.9%) and further increased BMD gains at the lumbar spine (mean change from end of denosumab treatment of 5.3%). Upon transition to romosozumab (months 36–48), P1NP and β‐CTX levels gradually returned to baseline from their reduced values during denosumab administration. Transitioning to romosozumab after 12 months of denosumab appears to improve lumbar spine BMD and maintain total hip BMD while possibly preventing the rapid increase in levels of bone turnover markers above baseline expected upon denosumab discontinuation. © 2021 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.
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Affiliation(s)
- Michael R McClung
- Oregon Osteoporosis Center Portland Oregon USA.,Mary MacKillop Institute for Health Research Australian Catholic University Melbourne Victoria Australia
| | | | - Jacques P Brown
- Laval University and CHU de Quebec (CHUL) Research Centre Quebec City Quebec Canada
| | | | | | - Yifei Shi
- Amgen Inc. Thousand Oaks California USA
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Kobayakawa T, Suzuki T, Nakano M, Saito M, Miyazaki A, Takahashi J, Nakamura Y. Real-world effects and adverse events of romosozumab in Japanese osteoporotic patients: A prospective cohort study. Bone Rep 2021; 14:101068. [PMID: 33981812 PMCID: PMC8085670 DOI: 10.1016/j.bonr.2021.101068] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 04/10/2021] [Accepted: 04/13/2021] [Indexed: 11/27/2022] Open
Abstract
Real-world data on the new anti-sclerostin antibody drug, romosozumab, remain scarce. There is a strong need to accumulate and analyze data on romosozumab treatment for such conditions as osteoporosis. The purpose of this study was to investigate the therapeutic and adverse effects of romosozumab for osteoporosis treatment in clinical practice. Of the 230 osteoporosis patients prescribed romosozumab from September 2019 in this prospective multicenter cohort study, 204 patients completed 12 months of treatment. The primary outcome of interest was the rate of change in bone mineral density (BMD) of the lumbar spine, total hip, and femoral neck as measured by dual-energy X-ray absorptiometry. Secondary outcomes included changes in bone turnover markers and serum-corrected calcium level as well as the incidence of adverse events. At 6 and 12 months of romosozumab treatment, the respective percentage change in BMD from baseline was 7.4% and 12.2% for the lumbar spine, 1.8% and 5.8% for the total hip, and 2.9% and 6.0% for the femoral neck, all of which were significantly higher (P < 0.001) than baseline values. Patients who switched from another osteoporosis regimen exhibited significantly lower lumbar spine BMD gains versus treatment-naïve patients, especially for cases switching from denosumab. P1NP was significantly increased at 6 months (58.9%; P < 0.01), while TRACP-5b was significantly decreased at 6 months (-14.7%; P < 0.001) and 12 months (-18.8%; P < 0.001) versus baseline values. The largest rate of decrease in serum-corrected calcium was 3.7% at 12 months. Sixty-four (27.8%) of 230 patients experienced an adverse event, and 7 (3.0%) new fractures were recorded. In sum, romosozumab treatment for 12 months significantly improved lumbar spine, total hip, and femoral neck BMD according to real-world data.
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Affiliation(s)
- Tomonori Kobayakawa
- Kobayakawa Orthopedic and Rheumatologic Clinic, 1969 Kunou, Fukuroi, Shizuoka 437-0061, Japan
| | - Takako Suzuki
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan
- Department of Human Nutrition, Faculty of Human Nutrition, Tokyo Kasei Gakuin University, 22 Sanban-cho, Chiyoda-ku, Tokyo 102-8341, Japan
| | - Masaki Nakano
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan
| | - Makoto Saito
- Department of Clinical Support Office, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, 3-18-22 Honkagome, Bunkyou-ku, Tokyo 113-8677, Japan
| | - Akiko Miyazaki
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan
| | - Jun Takahashi
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan
| | - Yukio Nakamura
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan
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Ebina K, Tsuboi H, Nagayama Y, Kashii M, Kaneshiro S, Miyama A, Nakaya H, Kunugiza Y, Hirao M, Okamura G, Etani Y, Takami K, Goshima A, Miura T, Nakata K, Okada S. Effects of prior osteoporosis treatment on 12-month treatment response of romosozumab in patients with postmenopausal osteoporosis. Joint Bone Spine 2021; 88:105219. [PMID: 34020048 DOI: 10.1016/j.jbspin.2021.105219] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 05/04/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To investigate the effects of prior treatment and determine the predictors of a 12-month treatment response of romosozumab (ROMO) in 148 patients with postmenopausal osteoporosis. METHODS In this prospective, observational, and multicenter study, treatment naïve patients (Naïve; n=50) or patients previously treated with bisphosphonates (BP; n=37) or denosumab (DMAb; n=45) or teriparatide (TPTD; n=16) (mean age, 75.0 years; T-scores of the lumbar spine [LS] -3.2 and total hip [TH] -2.6) were switched to ROMO due to insufficient effects of prior treatment. Bone mineral density (BMD) and serum bone turnover markers were evaluated for 12 months. RESULTS At 12 months, changes in LS BMD were Naïve (18.2%), BP (10.2%), DMAb (6.4%), and TPTD (11.2%) (P<0.001 between groups) and changes in TH BMD were Naïve (5.6%), BP (3.3%), DMAb (0.6%), and TPTD (4.4%) (P<0.01 between groups), respectively. In all groups, the LS BMD significantly increased from baseline at 6 and 12 months, although only the DMAb group failed to obtain a significant increase in TH BMD during 12-month treatment. Mean values of N-terminal type I procollagen propeptide (PINP; μg/L) from baseline → 1 month → 12 months were Naïve (67.9 → 134.1 → 51.0), BP (32. 2 → 81.7 → 40.9), DMAb (30.4 → 56.2 → 75.3), and TPTD (97.4 → 105.1 → 37.1), and those of isoform 5b of tartrate-resistant acid phosphatase (TRACP-5b; mU/dL) were Naïve (500.4 → 283.8 → 267.1), BP (273.4 → 203.1 → 242.0), DMAb (220.3 → 246.1 → 304.8), and TPTD (446.6 → 305.1 → 235.7), respectively. Multiple regression analysis revealed that the significant predictors of BMD change at 12 months were difference of prior treatment (r=-2.8, P<0.001) and value of PINP at 1 month (r=0.04, P<0.01) for LS, and difference of prior treatment (r=-1.3, P<0.05) and percentage change of TRACP-5b at 1 month (r=-0.06, P<0.05) for TH. CONCLUSIONS The early effects of ROMO on LS and TH BMD increase at 12 months were significantly affected by the difference of prior treatment and are predicted by the early change in bone turnover markers.
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Affiliation(s)
- Kosuke Ebina
- Department of Musculoskeletal Regenerative Medicine, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Osaka, Suita 565-0871, Japan; Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka, Suita 565-0871, Japan.
| | - Hideki Tsuboi
- Department of Orthopaedic Surgery, Osaka Rosai Hospital, 1179-3 Nagasone-cho, Sakai, Kita-ku 591-8025, Japan
| | - Yoshio Nagayama
- Nagayama Rheumatology and Orthopaedic Clinic, 4-3-25 Hiokisounishi-machi, Sakai, Higashi-ku 599-8114, Japan
| | - Masafumi Kashii
- Department of Orthopaedic Surgery, Toyonaka Municipal Hospital, 4-14-1 Shibahara-cho, Osaka, Toyonaka 560-8565, Japan
| | - Shoichi Kaneshiro
- Department of Orthopaedic Surgery, Osaka Toneyama Medical Center, 5-1-1 Toneyama, Osaka, Toyonaka 560-8552, Japan
| | - Akira Miyama
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka, Suita 565-0871, Japan
| | - Hiroyuki Nakaya
- Department of Orthopaedic Surgery, Japan Community Health care Organization, Osaka Hospital, 4-2-78 Fukushima, Fukushima Ward, Osaka 553-0003, Japan
| | - Yasuo Kunugiza
- Department of Orthopaedic Surgery, Japan Community Health care Organization, Hoshigaoka Medical Center, 4-8-1 Hoshigaoka, 573-8511, Hirakata, Osaka, Japan
| | - Makoto Hirao
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka, Suita 565-0871, Japan
| | - Gensuke Okamura
- Department of Orthopaedic Surgery, Osaka Rosai Hospital, 1179-3 Nagasone-cho, Sakai, Kita-ku 591-8025, Japan
| | - Yuki Etani
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka, Suita 565-0871, Japan
| | - Kenji Takami
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka, Suita 565-0871, Japan
| | - Atsushi Goshima
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka, Suita 565-0871, Japan
| | - Taihei Miura
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka, Suita 565-0871, Japan
| | - Ken Nakata
- Department of Health and Sport Sciences, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Osaka, Suita 565-0871, Japan
| | - Seiji Okada
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka, Suita 565-0871, Japan
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New therapeutic options for bone diseases. Wien Med Wochenschr 2021; 171:120-125. [PMID: 33512621 DOI: 10.1007/s10354-020-00810-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 12/28/2020] [Indexed: 02/07/2023]
Abstract
In recent years, new treatment options for both common and rare bone diseases have become available. The sclerostin antibody romosozumab is the most recently approved drug for the therapy of postmenopausal osteoporosis. Its anabolic capacity makes it a promising treatment option for severe osteoporosis. Other sclerostin antibodies for the treatment of rare bone diseases such as osteogenesis imperfecta are currently being investigated. For rare bone diseases such as X‑linked hypophosphatemia (XLH) and hypophosphatasia (HPP), specific therapies are now also available, showing promising data in children and adults with a severe disease course. However, long-term data are needed to assess a sustained benefit for patients.
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Anti-Sclerostin Antibodies in Osteoporosis and Other Bone Diseases. J Clin Med 2020; 9:jcm9113439. [PMID: 33114755 PMCID: PMC7694131 DOI: 10.3390/jcm9113439] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 10/19/2020] [Accepted: 10/20/2020] [Indexed: 12/11/2022] Open
Abstract
The Wnt pathway is a key element of bone remodeling; its activation stimulates bone formation and inhibits bone resorption. The discovery of sclerostin, a natural antagonist of the Wnt pathway, promoted the development of romosozumab, a human monoclonal antibody directed against sclerostin, as well as other anti-sclerostin antibodies. Phase 3 studies have shown the efficacy of romosozumab in the prevention of fractures in postmenopausal women, against placebo but also against alendronate or teriparatide and this treatment also allows bone mineral density (BMD) increase in men. Romosozumab induces the uncoupling of bone remodeling, leading to both an increase in bone formation and a decrease in bone resorption during the first months of treatment. The effect is attenuated over time and reversible when stopped but transition with anti-resorbing agents allows the maintenance or reinforcement of BMD improvements. Some concerns were raised about cardiovascular events. Therefore, romosozumab was recently approved in several countries for the treatment of severe osteoporosis in postmenopausal women with high fracture risk and without a history of heart attack, myocardial infarction or stroke. This review aims to outline the role of sclerostin, the efficacy and safety of anti-sclerostin therapies and in particular romosozumab and their place in therapeutic strategies against osteoporosis or other bone diseases.
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