Abstract: TH-OR061
Effect of Denosumab on Bone Mineral Density and Microarchitecture Assessed by High-Resolution Peripheral Quantitative CT (HRpQCT) in Bone Biopsies from Patients on Dialysis: A Longitudinal Study
Session Information
- New Developments in Bones, Stones, and Mineral Metabolism
November 06, 2025 | Location: Room 370A, Convention Center
Abstract Time: 05:30 PM - 05:40 PM
Category: Bone and Mineral Metabolism
- 502 Bone and Mineral Metabolism: Clinical
Authors
- Urena Torres, Pablo A., AURA Paris, Saint-Ouen, Île-de-France, France
- Batteux, Benjamin, Centre Hospitalier Universitaire Amiens-Picardie, Amiens, Hauts-de-France, France
- Cohen-Solal, Martine, Hopital Lariboisiere, Paris, Île-de-France, France
Background
Denosumab has been shown to increase bone mineral density (BMD) in dialysis patients, but its effects on trabecular and cortical bone microarchitecture assessed by high-resolution peripheral quantitative computed tomography (HRpQCT) have not been reported.
Methods
We conducted a longitudinal study including 32 consecutive dialysis patients managed at a single center between 2014 and 2024 and having performed at least one HRpQCT. The study protocol included a HRpQCT at the distal tibia and radius at baseline and every year. After exclusion of osteomalacia mainly assessed by bone biopsy, and ensuring well-controlled parathyroid hormone levels according to the target recommendations, patients with recent fractures were treated with denosumab. We compared changes in HRpQCT parameters over time between denosumab-treated and non-treated patients, using linear mixed models for repeated measures, and analyzed baseline histomorphometric parameters as predictors of changes in HRpQCT parameters over time.
Results
During a median [minimum – maximum] follow-up period of 1.8 [0.7 – 4.9] years, 19 dialysis patients had repeated HRpQCTs over time, including nine patients treated with denosumab. Compared to the non-treated group, denosumab-treated patients had a significant preservation in (i) ratio of bone volume to total volume at the distal tibia (p=0.006) and radius (p=0.002), (ii) trabecular volumetric BMD at the distal tibia (p=0.006) and radius (p=0.002), (iii) trabecular number at the distal radius (p<0.001), and (iv) trabecular separation at distal tibia (p=0.025) and radius (p<0.001). The cortical parameters changes were not statistically significant between groups. At most, changes in trabecular volumetric BMD at the radius tended to be negatively associated with osteoid volume.
Conclusion
Our real-life study shows that denosumab treatment improves trabecular bone parameters over time in dialysis patients, thus preventing the persistent and progressive trabecular bone loss observed in the absence of treatment. Furthermore, our results suggest that the optimal effect of denosumab could be achieved in the absence of mineralization defect, supporting the importance of performing a bone biopsy prior to the introduction of denosumab in this population.