Effects of denosumab on bone mineral density and renal function in postmenopausal women transitioning from raloxifene

Chung-Hua Chu^a, †, Kuang-Ting Yeh^{a, b}, †, Ru-Ping Lee^b, Ing-Ho Chen^{a, c}, Tzai-Chiu Yu^{a, c}, Kuan-Lin Liu^a, Cheng-Huan Peng^a, Jen-Hung Wang^d, Wen-Tien Wu^{a, b, c}

^a Department of Orthopedics, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
^b Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan
^c School of Medicine, Tzu Chi University, Hualien, Taiwan
^d Department of Medical Research, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan

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Abstract

Objectives

Denosumab is a human recombinant monoclonal antibody that has been approved for the treatment of postmenopausal osteoporosis in women with a high risk of fracture. The antibody binds the receptor activator of nuclear factor κB ligand, which blocks the maturation, function, and survival of osteoclasts, and therefore reduces bone resorption. Many patients treated with denosumab for osteoporosis have previously received other antiresorptive therapy that may influence the antiosteoporotic effect. The aim of this study is to elucidate if transition from raloxifene to denosumab is beneficial in antiosteoporotic treatment.

Materials and methods

This retrospective study recruited postmenopausal women with bone mineral density (BMD) T-scores in the lumbar spine (LS) or femoral neck (FN) ≤ −2.5 who received regular treatment with raloxifene or/and denosumab. The patients were divided into three groups. The R group received oral raloxifene 60 mg daily for at least 24 months. The D group received subcutaneous denosumab 60 mg every 6 months for at least 24 months. The T group received raloxifene for at least 6 months, and then shifted to denosumab for at least 18 months. BMD and renal function were also evaluated in these patients.

Results

Approximately 60% of patients adhered to the raloxifene regimen and ∼95% adhered to the denosumab regimen. Spine BMD increased less in the T group than in the D group at Month 24. BMD in the spine and hip increased more in the T group than the R group. There was no deterioration of renal function or adverse events in any of the three groups.

Conclusion

Patients who transitioned from raloxifene to denosumab showed good adherence with treatment and significant improvement in BMD in the spine and hip without a negative influence on renal function. Discussing the characteristics of both drugs and the best antiosteoporotic treatment with patients is critical for satisfactory results in the prevention of fractures.

Keywords

Adherence; Denosumab; Postmenopausal osteoporosis; Raloxifene; Transition