Long-term denosumab treatment restores cortical bone loss and reduces fracture risk at the forearm and humerus: analyses from the FREEDOM Extension cross-over group

• Published in: Osteoporosis international Vol. 30; no. 9; pp. 1855 - 1864
• Main Authors: Bilezikian, J.P., Lin, C.J.F., Brown, J.P., Wang, A.T., Yin, X., Ebeling, P.R., Fahrleitner-Pammer, A., Franek, E., Gilchrist, N., Miller, P.D., Simon, J.A., Valter, I., Zerbini, C.A.F., Libanati, C., Chines, A.
• Format: Journal Article
• Language: English
• Published: London Springer London 01.09.2019; Springer Nature B.V
• Subjects: Aged; Aged, 80 and over; Bone density; Bone Density - drug effects; Bone Density Conservation Agents - administration & dosage; Bone Density Conservation Agents - therapeutic use; Bone loss; Bone mineral density; Cancellous bone; Cortical bone; Cortical Bone - drug effects; Cross-Over Studies; Denosumab - administration & dosage; Denosumab - therapeutic use; Double-Blind Method; Drug Administration Schedule; Endocrinology; Female; Follow-Up Studies; Forearm; Forearm Injuries - prevention & control; Fractures; Hip; Humans; Humeral Fractures - prevention & control; Humerus; Immunotherapy; Injections, Subcutaneous; Medicine; Medicine & Public Health; Middle Aged; Monoclonal antibodies; Morbidity; Original; Original Article; Orthopedics; Osteoporosis; Osteoporosis, Postmenopausal - drug therapy; Osteoporosis, Postmenopausal - physiopathology; Osteoporotic Fractures - prevention & control; Post-menopause; Radius; Radius - physiopathology; Rheumatology; TRANCE protein; Vertebrae; Wrist; Wrist Injuries - prevention & control; BMD; Osteoporosis; Fractures; Denosumab
• ISSN: 0937-941X; 1433-2965; 1433-2965
• DOI: 10.1007/s00198-019-05020-8

Summary Upper limb fractures (including wrist, forearm, and humerus) represent a significant burden among postmenopausal women with osteoporosis. Up to 7 years of treatment with denosumab resulted in an increase in bone mineral density and decrease in fractures in upper limb sites. Introduction Upper limb (wrist, forearm, and humerus) fractures are a significant burden in osteoporosis, associated with significant morbidity and mortality. Denosumab, a monoclonal antibody against RANK ligand, increases bone mineral density (BMD) and decreases vertebral, nonvertebral, and hip fractures. Here, we evaluated the long-term effect of denosumab treatment on upper limb fracture risk and BMD. Methods In the FREEDOM trial, subjects were randomized 1:1 to receive every-6-month denosumab 60 mg or placebo subcutaneously for 3 years, after which all subjects could receive denosumab for up to 7 years (Extension). Among placebo subjects who completed FREEDOM and enrolled in the Extension, wrist, forearm, humerus, and upper limb fracture rates and rate ratios between different time periods (FREEDOM years 1–3, Extension years 1–3, and Extension years 4–7) were computed. BMD at the ultradistal radius, 1/3 radius, and total radius was analyzed in a subset of subjects in a BMD substudy. Results This analysis included 2207 subjects (116 in the BMD substudy). Fracture rates decreased over the 7-year Extension; fracture rate ratios between Extension years 4–7 (denosumab) and FREEDOM years 1–3 (placebo) reduced significantly for the wrist (0.57), forearm (0.57), humerus (0.42), and upper limb (0.52; p  < 0.05 for all). Percentage increase in BMD from Extension baseline at the ultradistal radius, 1/3 radius, and total radius was significant by Extension year 7 ( p  < 0.05 for all). Conclusions Long-term treatment with denosumab decreases upper limb fracture risk and increases forearm BMD, suggesting beneficial effects on both cortical and trabecular bone accruing over time.