Risk factors for nonresponse to 2 years of denosumab administration in patients with osteoporosis: A retrospective single-center cohorts study

Akiko Yamamoto; Masashi Nagao; Yuji Nishizaki; Eri Maeda; Muneaki Ishijima

doi:10.1002/hsr2.1993

Risk factors for nonresponse to 2 years of denosumab administration in patients with osteoporosis: A retrospective single-center cohorts study

Health Sci Rep. 2024 Apr 4;7(4):e1993. doi: 10.1002/hsr2.1993. eCollection 2024 Apr.

Authors

Akiko Yamamoto¹, Masashi Nagao^{1

2

3

4}, Yuji Nishizaki^{1

2}, Eri Maeda^{3

5}, Muneaki Ishijima³

Affiliations

¹ Clinical Translational Science Juntendo University Graduate School of Medicine Tokyo Japan.
² Medical Technology Innovation Center Juntendo University Tokyo Japan.
³ Department of Medicine for Orthopaedics and Motor Organ Juntendo University Graduate School of Medicine Tokyo Japan.
⁴ Department of Sports Medicine Juntendo University School of Sports and Health Science Chiba Japan.
⁵ Department of Orthopaedic Surgery Juntendo Tokyo Koto Geriatric Medical Center Tokyo Japan.

Abstract

Background and aims: To investigate the factors associated with changes in bone mineral density (BMD) and the incidence of fractures in osteoporotic patients treated with denosumab.

Methods: This retrospective study included 162 osteoporotic patients treated with denosumab for 24 months between 2013 and 2019. Patients were divided according to the changes in BMD as nonresponders (N_L group: <3% increase in lumbar spine BMD [LBMD], N_H group: <0% increase in femoral neck BMD [FNBMD]) or responders (R_L group: ≥3% increase in LBMD, R_H group: ≥0% increase in FNBMD).

Results: The respective changes in the LBMD and FNBMD after 24 months of denosumab treatment were 9.3% (95% confidence interval [CI]: 8.1-10.6) and 3.3% (95% CI: 2.1-4.5). Twenty-eight (17.3%) patients were in the N_L group, and 134 (82.7%) were in the R_L group. A history of bisphosphonate treatment was a risk factor for being in the N_L group (odds ratio [OR]: 3.84, 95% CI: 1.38-10.71, p = 0.007; adjusted OR: 3.21, 95% CI: 1.01-10.19, p = 0.048). Although the N_H (n = 48; 30.8%) and R_H (n = 108; 69.2%) groups had similar baseline characteristics, the N_H group had a significantly higher baseline FNBMD than the R_H group (p = 0.003). The change in FNBMD was negatively associated with the FNBMD at baseline (r = -0.34, p < 0.001). No new osteoporotic fractures occurred in either group during follow-up.

Conclusion: In osteoporotic patients receiving denosumab treatment, a history of bisphosphonate treatment was a risk factor for a lack of increase in LBMD, and a higher FNBMD at baseline was negatively associated with the change in FNBMD.

Keywords: bone mineral density; denosumab; nonresponder; osteoporosis; responder.