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Kidney Week

Abstract: FR-PO321

Denosumab and Fracture Events in Patients on Hemodialysis

Session Information

Category: Bone and Mineral Metabolism

  • 502 Bone and Mineral Metabolism: Clinical

Authors

  • Kobayashi, Arisa, Tokyo Jikeikai Ika Daigaku, Minato-ku, Tokyo, Japan
  • Nakashima, Akio, Tokyo Jikeikai Ika Daigaku, Minato-ku, Tokyo, Japan
  • Kato, Kazuhiko, Tokyo Jikeikai Ika Daigaku, Minato-ku, Tokyo, Japan
  • Yaginuma, Tatsuhiro, Keijin Hospital, Adachi-ku, Tokyo, Japan
  • Ohkido, Ichiro, Tokyo Jikeikai Ika Daigaku, Minato-ku, Tokyo, Japan
  • Yokoo, Takashi, Tokyo Jikeikai Ika Daigaku, Minato-ku, Tokyo, Japan
Background

It is known that the risk of fracture is much higher in patients with dialysis than general population. In recent years, osteoporosis treatment has become more widespread including hemodialysis patients. However, there are few studies that analyzed the efficacy of denosumab for fracture events in hemodialysis patients.

Methods

We conducted a retrospective observational study of inpatients and outpatients at a maintenance hemodialysis facility to clarify the association between denosumab use and fracture events. The study term was from December 2013 to December 2022 and compared the incidence of fractures in the denosumab-treated and non-treated groups. The analysis was performed using the Cox proportional hazards model with the presence or absence of fracture occurrence as the objective variables and the presence or absence of denosumab use, various patient backgrounds, and laboratory values as explanatory variables.

Results

A total of 263 patients were enrolled in the study, with a mean age of 71.7 ± 12.1 years. Among them, 35.4% were female, and the median duration of hemodialysis was 48 [IQR 4-114] months. The number of patients who developed fractures was 52 in the non-treated group and 8 in the denosumab-treated group. After adjustment for factors such as age, gender, prior fracture, serum intact parathyroid hormone, serum TRACP5b and bone specific alkaline phosphatase, analysis using the Cox proportional hazards model showed that patients treated with denosumab were significantly less likely to develop fractures (HR 0.42 [95% CI: 0.18-0.98]).
There were no significant differences in the incidence of hypocalcemia (OR 2.05[95%CI:0.79-5.29]. Our study has several limitations, such as single center study in Japan and small sample size, but our results have the potential to widespread fracture treatment by using denosumab for hemodialysis patients.

Conclusion

Our results suggest that denosumab may be effective in preventing fractures in hemodialysis patients. Further studies with larger sample sizes are warranted to validate and enhance the outcomes of this study.