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Kidney Week

Abstract: TH-PO587

Follow-Up of Bone Mineral Density Changes in De Novo Kidney Transplant Recipients Treated with Two Doses of the RANKL Inhibitor Denosumab

Session Information

Category: Bone and Mineral Metabolism

  • 402 Bone and Mineral Metabolism: Clinical

Authors

  • Kobel, Claudia Andrea, University Hospital Zurich, Zurich, Switzerland
  • Graf, Nicole, graf biostatistics, Winterthur, Switzerland
  • Wuthrich, Rudolf P., University Hospital Zurich, Zurich, Switzerland
  • Bonani, Marco, University Hospital Zurich, Zurich, Switzerland
Background

Studies in women with post-menopausal osteoporosis have shown that discontinuation of treatment with denosumab leads to an increased risk of vertebral fractures because of rebound bone turnover and rapid loss of bone mineral density (BMD).

Methods

In an extended analysis of a randomized clinical trial examining the effect of denosumab on BMD we analyzed the effect of denosumab withdrawal on BMD changes. A group of 25 de novo kidney transplant recipients (KTR) which were treated for 1 year with two six-monthly doses of denosumab (D) on top of standard treatment (daily calcium and vitamin D) were compared to a control group of 29 KTR which received standard treatment alone. BMD changes were analyzed by repeated DXA shortly after transplantation (baseline), after 6 and 12 months (active treatment phase) and once or twice after 2 to 6.5 years (follow-up phase).

Results

Figure 1 shows the change of total lumbar BMD (g/cm2) over time by randomisation group. The BMD at the lumbar spine declined markedly (arrow) after discontinuation of treatment with denosumab (D) but increased again thereafter. Thus, the average monthly change in lumbar spine BMD from month 12 onward was only 0.1±2.8‰ in the denosumab group but 1.5±1.9‰ in the control group (p=0.021). The average monthly change in lumbar spine BMD from baseline to follow up was similar in the control and denosumab group (1.1±1.2‰ vs 1.5±2.4‰, p=0.788). Similar results were seen at the total hip.

Conclusion

In de novo KTR treated with two doses of denosumab, we detect a marked decrease in lumbar spine and hip BMD when denosumab is discontinued. To prevent the decline in BMD after denosumab discontinuation, bisphosphonate treatment might be considered to antagonize the enhanced bone turnover.

Figure 1: Total lumbar BMD over time

Funding

  • Clinical Revenue Support