Denosumab treatment for osteoporosis in hemodialysis patients: Results of a 3-year prospective study

Abstract

Denosumab treatment was administered to hemodialysis outpatients who were complicated with osteoporosis (young adult mean [YAM]: <70%). Thirty-eight consecutive patients (13 males, 25 females; mean age: 70.8 years; range: 23-94 years, mean YAM: 52.1%) were recruited. Sixty mg of denosumab was administered subcutaneously every 6 months. After the start of denosumab treatment, the patients’ bone mineral density (BMD) at the 1/3 distal radius increased≧3 point over 3 years. Furthermore, their levels of tartrate-resistant acid phosphatase 5b (TRACP-5b, a bone absorption marker) and total procollagen 1 intact N-terminal (P1NP, a bone formation maker) significantly reduced over 3 years. The hemodialysis-induced change in the albumin-adjusted Ca level was significantly lower at the end of the study than at the administration of the first dose of denosumab, but the hemodialysis-induced change in the inorganic phosphate level did not change significantly during the study period. The dosage of an intravenous vitamin D preparation administered increased significantly due to the correction of hypocalcemia achieved by denosumab. Denosumab treatment improved BMD at the 1/3 distal radius in hemodialysis patients with osteoporosis. However, it is necessary to carefully observe the hemodialysis-induced changes in albumin-adjusted Ca levels in such cases.