Effects of denosumab on bone histomorphometry: the FREEDOM and STAND studies.
Denosumab, a human monoclonal antibody against RANKL, reversibly inhibits osteoclast-mediated bone resorption and has been developed for use in osteoporosis. Its effects on bone histomorphometry have not been described previously. Iliac crest bone biopsies were collected at 24 and/or 36 months from osteoporotic postmenopausal women in the FREEDOM study (45 women receiving placebo and 47 denosumab) and at 12 months from postmenopausal women previously treated with alendronate in the STAND study (21 continuing alendronate and 15 changed to denosumab at trial entry). Qualitative histologic evaluation of biopsies was unremarkable. In the FREEDOM study, median eroded surface was reduced by more than 80% and osteoclasts were absent from more than 50% of biopsies in the denosumab group. Double labeling in trabecular bone was observed in 94% of placebo bones and in 19% of those treated with denosumab. Median bone-formation rate was reduced by 97%. Among denosumab-treated subjects, those with double labels and those with absent labels had similar levels of biochemical markers of bone turnover. In the STAND trial, indices of bone turnover tended to be lower in the denosumab group than in the alendronate group. Double labeling in trabecular bone was seen in 20% of the denosumab biopsies and in 90% of the alendronate samples. Denosumab markedly reduces bone turnover and also reduces fracture numbers. Longer follow-up is necessary to determine how long such low turnover is safe.
Department of Medicine, University of Auckland, Auckland, New Zealand. i.reid@auckland.ac.nz
Ian R
IR
Reid
Paul D
PD
Miller
Jacques P
JP
Brown
David L
DL
Kendler
Astrid
A
Fahrleitner-Pammer
Ivo
I
Valter
Katre
K
Maasalu
Michael A
MA
Bolognese
Grattan
G
Woodson
Henry
H
Bone
Beiying
B
Ding
Rachel B
RB
Wagman
Javier
J
San Martin
Michael S
MS
Ominsky
David W
DW
Dempster
D000368:Aged; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized; D050071:Bone Density Conservation Agents / Q000627:therapeutic use*; D000069448:Denosumab; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008875:Middle Aged; D010919:Placebos; D053245:RANK Ligand / Q000627:therapeutic use*; D014057:Tomography, X-Ray Computed
D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D050071:Bone Density Conservation Agents; D010919:Placebos; D053245:RANK Ligand; D000069448:Denosumab