Endocrine Abstracts

Background: Osteoporosis is a chronic metabolic bone disease, highly prevalent in the elderly population, especially in postmenopausal women. Denosumab is a potent anti-resorptive drug, which can be used as an initial therapy or as an alternative therapy in the treatment of osteoporosis.

Objective: We aimed to analyze the characteristics of patients, the evolution of bone mass density (BMD) and trabecular bone score (TBS) and the factors associated with fragility fractures, all under treatment with Denosumab.

Methods: Between Nov 2013 and Nov 2023, 1375 patients were diagnosed with osteoporosis in our center, of which 184 patients received treatment with Denosumab and we had follow up for 81 patients, which included osteodensitometric (DXA scan) evaluation before and after the treatment with Denosumab and radiological vertebral fracture assessment.

Results: The patients had a mean age of 72 years, 98.8% women (97.5% postmenopausal), with an average BMI of 25.31 kg/m², 95% had an osteodensitometric score of osteoporosis and the median period of therapy with Denosumab was 3 years. The batch had an average lumbar spine T score of -3 DS and a TBS value of 1.235. Under Denosumab therapy, BMD increased at the level of all segments, the increase being statistically significant at the lumbar spine and the hip. Twenty-eight percent of patients presented secondary causes of osteoporosis: Hyperthyroidism (9.9%), diabetes 7.4%, hyperthyroidism (4.9%), acromegaly (2.5%), glucocorticoids therapy (2.5%), and hypogonadism (1.2%). We detected a history of old fragility fractures in 78% of the patients, the most common being vertebral fractures (48%). Before undergoing treatment with Denosumab 92% underwent treatment with bisphosphonates, 14.8% also with teriparatide and only 2% were treatment naive. Ten percent of patients suffered a fragility fracture during Denosumab therapy. We performed a comparative analysis of the group according to the occurrence of fragility fractures during Denosumab treatment and observed that patients with new fractures on therapy had significantly lower TBS at follow up and had a history of old hip fractures.

Conclusions: Fracture prevention is the main treatment goal in osteoporosis, as the fractures can be debilitating and can increase the likelihood of death. Denosumab has clear indications for osteoporotic patients and it is an effective treatment, that leads to substantial increases in bone mass. The potential for fractures to occur upon treatment, especially at patients with a history of old hip fractures and those who have lower TBS at follow-up, as seen in our study, requires close-up management.