Femoral and Vertebral Strength Improvements in Postmenopausal Women With Osteoporosis Treated With Denosumab |
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| Authors: | Tony M Keaveny Michael R McClung Harry K Genant Jose R Zanchetta David Kendler Jacques P Brown Stefan Goemaere Chris Recknor Maria L Brandi Richard Eastell David L Kopperdahl Klaus Engelke Thomas Fuerst Hoi‐Shen Radcliffe Cesar Libanati |
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| Institution: | 1. University of California Berkeley, Berkeley, CA, USA;2. O.N. Diagnostics, Berkeley, CA, USA;3. Oregon Osteoporosis Center, Portland, OR, USA;4. University of California San Francisco, CA, USA;5. Synarc Inc., San Francisco, CA, USA;6. IDIM, Buenos Aires, Argentina;7. University of British Columbia, Vancouver, Canada;8. CHU de Québec Research Centre, Québec, Canada;9. Ghent University Hospital, Ghent, Belgium;10. United Osteoporosis Centers, Gainesville, GA, USA;11. University of Florence, Florence, Italy;12. University of Sheffield, Sheffield, UK;13. Synarc Inc., Hamburg, Germany;14. Institute of Medical Physics, University of Erlangen, Erlangen, Germany;15. Amgen Ltd., Cambridge, UK;16. Amgen Inc., Thousand Oaks, CA, USA |
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| Abstract: | In the randomized, placebo‐controlled FREEDOM study of women aged 60 to 90 years with postmenopausal osteoporosis, treatment with denosumab once every 6 months for 36 months significantly reduced hip and new vertebral fracture risk by 40% and 68%, respectively. To gain further insight into this efficacy, we performed a nonlinear finite element analysis (FEA) of hip and spine quantitative computed tomography (QCT) scans to estimate hip and spine strength in a subset of FREEDOM subjects (n = 48 placebo; n = 51 denosumab) at baseline, 12, 24, and 36 months. We found that, compared with baseline, the finite element estimates of hip strength increased from 12 months (5.3%; p < 0.0001) and through 36 months (8.6%; p < 0.0001) in the denosumab group. For the placebo group, hip strength did not change at 12 months and decreased at 36 months (–5.6%; p < 0.0001). Similar changes were observed at the spine: strength increased by 18.2% at 36 months for the denosumab group (p < 0.0001) and decreased by –4.2% for the placebo group (p = 0.002). At 36 months, hip and spine strength increased for the denosumab group compared with the placebo group by 14.3% (p < 0.0001) and 22.4% (p < 0.0001), respectively. Further analysis of the finite element models indicated that strength associated with the trabecular bone was lost at the hip and spine in the placebo group, whereas strength associated with both the trabecular and cortical bone improved in the denosumab group. In conclusion, treatment with denosumab increased hip and spine strength as estimated by FEA of QCT scans compared with both baseline and placebo owing to positive treatment effects in both the trabecular and cortical bone compartments. These findings provide insight into the mechanism by which denosumab reduces fracture risk for postmenopausal women with osteoporosis. © 2014 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals, Inc. on behalf of the American Society for Bone and Mineral Research. This is an open access article under the terms of the Creative Commons Attribution–NonCommercial–NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made. |
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| Keywords: | DENOSUMAB HIP STRENGTH SPINE STRENGTH FINITE ELEMENT ANALYSIS OSTEOPOROSIS |
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