Clin Osteol 2016; 21(4): 111-118

Denosumab in the treatment of osteoporosis in patients after organ transplantationReview articles

J. Brunová, S. Kratochvílová, J. Štěpánková

Introduction: Osteoporosis and osteopenia are some of the long-term complications in patients after successful organ transplantation. The role in the pathogenesis, which is complex and multifactorial, is played by bone loss in advanced organ failure and, in the post­

transplantation period, mainly by immunosuppressive therapy including steroids, secondary hyperparathyroidism and vitamin D deficiency. Apart from the administration of calcium and vitamin D, osteoporosis is mainly treated with bisphosphonates. Their use, however, is limited by the presence of impaired renal function which is relatively common in patients after organ transplantation. In such cases, osteoporosis may be treated with denosumab, a monoclonal antibody against receptor activator of nuclear factor kappa B ligand

(RANKL). However, there is not much experience with the administration of denosumab in transplanted patients.

Patients and methods: The study followed 46 patients after organ transplantation (27 females and 19 males; a mean age of 56.2 years) who were treated for osteoporosis with denosumab. The organs transplanted were both the kidney and pancreas in 13 patients, the liver in 15 patients, the kidney in 16 patients and the heart in 2 patients. The mean time from transplantation was 8.6 years. Osteoporosis was diagnosed by densitometry using the Lunar Prodigy system according to the WHO criteria.

Results: Osteoporosis of the lumbar spine was diagnosed in 35/46 patients (76 %), osteoporosis of the hip in 22/46 patients (48 %) and osteoporosis of the distal radius in 25/46 patients (54 %). Denosumab therapy increased the BMD of the lumbar spine in all patients. The BMD of the hip and forearm increased in 42/46 (91 %) and 28/46 (61 %) patients, respectively. Following the therapy, the BMD of the lumbar spine increased in 35/35 osteoporotic patients (100 %), with a mean BMD increase of 10.9 %. The BMD of the hip increased in 22/22 patients (100 %), with a mean BMD increase of 9 %; the BMD of the forearm increased in 17/25 patients (68 %), a mean increase of 4.5 %. The rates of osteoporosis decreased from 76 % to 26 % for osteoporosis of the lumbar spine, from 48 % to 28 % for osteoporosis of the hip and from 54 % to 41 % for osteoporosis of the forearm. T-scores of the lumbar spine increased significantly both in the entire sample (p < 0.0001) and in patients with osteoporosis of the lumbar spine (p<0.0001). Similarly, T-scores of the hip increased significantly in both osteoporotic patients (p = 0.0019) and the entire sample (p < 0.001). There were no significant differences in the BMD of the forearm prior to and after the therapy.

Conclusion: The administration of denosumab to patients after transplantation of solid organs significantly increased BMD and was well tolerated. Thus, denosumab may be used to treat osteoporosis in patients contraindicated for bisphosphonates due to impaired renal function, intolerance or failure of therapy.

Keywords: denosumab, orgánová transplantace, osteoporóza

Published: December 11, 2016  Show citation