title: Denosumab increases sublesional bone mass in osteoporotic individuals with recent spinal cord injury.
abstract: Osteoporosis is a frequent complication related to spinal cord injury (SCI), and data on osteoporosis treatment after SCI is scarce. Treatment with denosumab increases lumbar and femoral BMD and decreases bone turnover markers in individuals with recent SCI. This drug may be a promising therapeutic option in SCI-related osteoporosis.
  
  
  BACKGROUND
  Osteoporosis development is a frequent complication related to SCI, especially at the sublesional level. Nevertheless, data on osteoporosis treatment after SCI is scarce, particularly short term after injury, when the highest bone loss is produced. The aim of this study was to analyze the efficacy of denosumab in the treatment of SCI-related osteoporosis.
  
  
  METHODS
  Fourteen individuals aged 39 ± 15 years with osteoporosis secondary to recent SCI (mean injury duration 15 ± 4 months) were treated with denosumab for 12 months. Bone turnover markers (BTMs) (PINP, bone ALP, sCTx), 25-hydroxyvitamin D (25OHD) levels and bone mineral density (BMD) at the lumbar spine (LS), total hip (TH), and femoral neck (FN) were assessed at baseline and at 12 months. All participants received calcium and vitamin D supplementation.
  
  
  RESULTS
  At 12 months, SCI denosumab-treated participants showed a significant increase in BMD at TH (+2.4 ± 3.6 %, p = 0.042), FN (+3 ± 3.6 %, p = 0.006), and LS (+7.8 ± 3.7 %, p < 0.001) compared to baseline values. Denosumab treatment was associated with significant decreases in BTMs (bone ALP -42 %, p < 0.001; PINP -58 %, p < 0.001, sCTx -57 %, p = 0.002) at 12 months. BMD evolution was not related to BTM changes or 25OHD serum levels. No skeletal fractures or serious adverse events were observed during follow-up.
  
  
  CONCLUSIONS
  Treatment with denosumab increases lumbar and femoral BMD and decreases bone turnover markers in individuals with recent SCI. This drug may be a promising therapeutic option in SCI-related osteoporosis.
authors.affiliation: Metabolic Bone Diseases Unit, Service of Rheumatology, Hospital Clinic of Barcelona, Villarroel 170, Barcelona, 08036, Spain. lgifre@clinic.ub.es.
authors.forename: L
authors.initials: L
authors.lastname: Gifre
authors.affiliation: Guttmann Neurorehabilitation Institute, Universitat Autònoma de Barcelona, Badalona, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Vidal
authors.affiliation: Public Health Department, University of Barcelona, Barcelona, Spain.
authors.forename: J L
authors.initials: JL
authors.lastname: Carrasco
authors.affiliation: Nuclear Medicine Department, Hospital Clinic of Barcelona, Barcelona, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Muxi
authors.affiliation: Guttmann Neurorehabilitation Institute, Universitat Autònoma de Barcelona, Badalona, Spain.
authors.forename: E
authors.initials: E
authors.lastname: Portell
authors.affiliation: Metabolic Bone Diseases Unit, Service of Rheumatology, Hospital Clinic of Barcelona, Villarroel 170, Barcelona, 08036, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Monegal
authors.affiliation: Metabolic Bone Diseases Unit, Service of Rheumatology, Hospital Clinic of Barcelona, Villarroel 170, Barcelona, 08036, Spain.|CIBERehd, Madrid, Spain.
authors.forename: N
authors.initials: N
authors.lastname: Guañabens
authors.affiliation: Metabolic Bone Diseases Unit, Service of Rheumatology, Hospital Clinic of Barcelona, Villarroel 170, Barcelona, 08036, Spain.|CIBERehd, Madrid, Spain.
authors.forename: P
authors.initials: P
authors.lastname: Peris
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D015519:Bone Density / Q000187:drug effects*; D050071:Bone Density Conservation Agents / Q000627:therapeutic use*; D016723:Bone Remodeling / Q000187:drug effects / Q000502:physiology; D000069448:Denosumab / Q000627:therapeutic use*; D005260:Female; D005272:Femur Neck / Q000187:drug effects / Q000503:physiopathology; D005500:Follow-Up Studies; D006621:Hip Joint / Q000187:drug effects / Q000503:physiopathology; D006801:Humans; D008159:Lumbar Vertebrae / Q000187:drug effects / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D013119:Spinal Cord Injuries / Q000150:complications* / Q000503:physiopathology; D055815:Young Adult
chemical_list: D015415:Biomarkers; D050071:Bone Density Conservation Agents; D000069448:Denosumab
keywords: Bone mineral density; Bone turnover markers; Denosumab; Osteoporosis; Spinal cord injury