scholarly journals Effect of denosumab on trabecular bone score in de novo kidney transplant recipients

2019 ◽  
Vol 34 (10) ◽  
pp. 1773-1780 ◽  
Author(s):  
Marco Bonani ◽  
Diana Frey ◽  
Nicole Graf ◽  
Rudolf P Wüthrich
Keyword(s):  
Lumbar Spine ◽  
Trabecular Bone ◽  
Kidney Transplant ◽  
De Novo ◽  
Trabecular Bone Score ◽  
Distal Tibia ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Mineral Density ◽  
Total Hip

Abstract Background Kidney transplant recipients (KTR) are at risk to lose bone mass. The trabecular bone score (TBS) represents a recently developed parameter of lumbar spine trabecular bone texture that correlates with the occurrence of fractures. Methods We analysed the 1-year changes in TBS in 44 de novo KTR that were randomized 1:1 to denosumab or no treatment. TBS was derived from dual energy X-ray absorptiometry and was correlated with 1-year areal bone mineral density (aBMD) changes at the lumbar spine and total hip. Correlations were also performed with parameters of peripheral bone microarchitecture and bone strength at the distal tibia and distal radius, as assessed by high-resolution peripheral quantitative computed tomography (HRpQCT) and micro-finite element analysis. Results The baseline TBS in KTR amounted to 1.312 ± 0.101, which is lower than the TBS of an age-matched normal control population (range 1.364–1.471). The TBS correlated positively with aBMD at the lumbar spine (Spearman’s ρ = 0.56; P < 0.001) and total hip (ρ = 0.33; P < 0.05). The baseline TBS also correlated with HRpQCT-derived total (ρ = 0.49; P < 0.05) and trabecular volumetric BMD (ρ = 0.57; P < 0.01) and trabecular separation (ρ = −0.46; P < 0.05) at the tibia. Denosumab treatment led to an increase in TBS, paralleling the BMD changes at the lumbar spine. Conclusions The TBS is a useful additional score of bone health, which may help to better define fracture risk. Treatment with denosumab led to improved trabecular bone texture in de novo KTR in addition to its beneficial effect on BMD.

scholarly journals Bone mineral density, bone turnover markers, and incident fractures in de novo kidney transplant recipients

2019 ◽  
Vol 95 (6) ◽  
pp. 1461-1470 ◽  
Author(s):  
Pieter Evenepoel ◽  
Kathleen Claes ◽  
Bjorn Meijers ◽  
Michaël R. Laurent ◽  
Bert Bammens ◽  
...  
Keyword(s):  
Bone Mineral Density ◽  
Bone Turnover ◽  
Kidney Transplant ◽  
Bone Mineral ◽  
Bone Turnover Markers ◽  
De Novo ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Mineral Density ◽  
Turnover Markers

scholarly journals Follow-Up of Bone Mineral Density Changes in de novo Kidney Transplant Recipients Treated with Two Doses of the Receptor Activator of Nuclear Factor κB Ligand Inhibitor Denosumab

2019 ◽  
Vol 44 (5) ◽  
pp. 1285-1293 ◽  
Author(s):  
Claudia Kobel ◽  
Diana Frey ◽  
Nicole Graf ◽  
Rudolf P. Wüthrich ◽  
Marco Bonani
Keyword(s):  
Lumbar Spine ◽  
Standard Treatment ◽  
De Novo ◽  
Control Group ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Mineral Density ◽  
Discontinuation Of Treatment ◽  
Monthly Change

Background: Studies in women with post-menopausal osteoporosis have shown that discontinuation of treatment with denosumab leads to an increased risk of vertebral fractures because of rebound bone turnover and rapid loss of bone mineral density (BMD). Methods: In a post hoc analysis of the Prolia for Osteoporosis of Transplant Operated Patient study, we analyzed the effect of denosumab withdrawal on BMD changes. Twenty-five de novo kidney transplant recipients (KTR) who were treated for 1 year with 2 six-monthly doses of denosumab on top of standard treatment (daily calcium and vitamin D) were compared to a control group of 29 KTR who received standard treatment alone. BMD changes were analyzed by repeated dual-energy X-ray absorptiometry shortly after transplantation (baseline), after 6 and 12 months (active treatment phase) and after 2–6.5 years (follow-up phase). Results: The average BMD at the lumbar spine declined markedly after discontinuation of treatment with denosumab but increased again thereafter. Thus, the average monthly change in lumbar spine BMD from month 12 onward was only 0.1 ± 2.8‰ in the denosumab group but 1.5 ± 1.9‰ in the control group (p = 0.021). The average monthly change in lumbar spine BMD from baseline to follow-up was similar in the control and denosumab group (1.1 ± 1.2‰ vs. 1.5 ± 2.4‰, p = 0.788). Similar results were seen at the total hip. Conclusions: In de novo KTR treated with 2 doses of denosumab, we detect a marked decrease in lumbar spine and hip BMD when denosumab is discontinued. Denosumab treatment should therefore not be discontinued without considering an alternative antiresorptive treatment.

scholarly journals Marine n-3 Polyunsaturated Fatty Acids and Bone Mineral Density in Kidney Transplant Recipients: A Randomized, Placebo-Controlled Trial

Nutrients ◽  
2021 ◽  
Vol 13 (7) ◽  
pp. 2361
Author(s):  
Hanne Skou Jørgensen ◽  
Ivar Anders Eide ◽  
Trond Jenssen ◽  
Anders Åsberg ◽  
Jens Bollerslev ◽  
...  
Keyword(s):  
Bone Mineral Density ◽  
Fatty Acids ◽  
Lumbar Spine ◽  
Kidney Transplant ◽  
Bone Mineral ◽  
Controlled Trial ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Mineral Density ◽  
Pufa Supplementation

Kidney transplant recipients are at high risk of progressive bone loss and low-energy fractures in the years following transplantation. Marine n-3 polyunsaturated fatty acids (n-3 PUFA) supplementation may have beneficial effects on bone strength. The Omega-3 fatty acids in Renal Transplantation (ORENTRA) trial was an investigator initiated, randomized, placebo-controlled trial investigating the effects of marine n-3 PUFA supplementation after kidney transplantation. Effects of supplementation on bone mineral density (BMD) and calcium metabolism were pre-defined secondary endpoints. Adult kidney transplant recipients (n = 132) were randomized to 2.6 g marine n-3 PUFA supplement or olive oil (control) from 8 to 52 weeks post-transplant. Dual energy X-ray absorptiometry was performed to assess changes in bone mineral density of hip, spine, and forearm, as well as trabecular bone score (TBS) of the lumbar spine. Student’s t test was used to assess between-group differences. There were no differences in ΔBMD between the two groups (intervention vs. control) at lumbar spine (−0.020 ± 0.08 vs. −0.007 ± 0.07 g/cm², p = 0.34), total hip (0.001 ± 0.03 vs. −0.005 ± 0.04, p = 0.38), or other skeletal sites in the intention-to-treat analyses. There was no difference in the change in TBS score (0.001 ± 0.096 vs. 0.009 ± 0.102, p = 0.62). Finally, no effect on biochemical parameters of mineral metabolism was seen. Results were similar when analyzed per protocol. In conclusion, we found no significant effect of 44 weeks of supplementation with 2.6 g of marine n-3 PUFA on BMD in kidney transplant recipients.

scholarly journals AB0711 USEFULNESS OF THE TRABECULAR BONE SCORE AS A PREDICTOR OF VERTEBRAL FRACTURE IN PATIENTS WITH AXIAL SPONDYLOARTHROPATHY

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1650.3-1651
Author(s):  
A. V. Orenes Vera ◽  
L. Montolio-Chiva ◽  
I. Vázquez-Gómez ◽  
E. Flores ◽  
E. Valls-Pascual ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Lumbar Spine ◽  
Vertebral Fracture ◽  
Trabecular Bone ◽  
Vertebral Fractures ◽  
Trabecular Bone Score ◽  
Univariate Analysis ◽  
Mineral Density ◽  
Total Hip ◽  
The Mean

Background:In axial spondyloarthritis (axSpA) the risk of vertebral fracture is increased, not always corresponding with the values of bone mineral density (BMD). One possible explanation is that syndesmophytes interfere with these values. We consider whether the evaluation of trabecular microarchitecture by an accessible methodlike the Trabecular Bone Score (TBS), that does not involve additional irradiation neither seem to be influenced by the presence of syndesmophytes, may be an advantage to estimate the risk of fracture.Objectives:To estimate the prevalence of vertebral fractures in patients with axSpA. To assess the diagnostic accuracy of TBS and BMD for vertebral fracture, and if it is influenced by the presence of syndesmophytes. To analyze the correlation between the absolute values of BMD and TBS in the lumbar spine.Methods:Cross-sectional study. Patients were consecutive recruited. We collected demographic (sex, age), clinical (syndesmophytes, vertebral fracture, BASDAI, BASFI, time of evolution of axSpA, treatment) and analytical variables [vitamin D (1,25-OHD), CRP and ESR]. The BMD was determined using the Lunar Prodigy ProTM densitometer from GE Healthcare, to which the TBS iNsight® software version 2.2 was added to perform the TBS analysis. The presence of fracture was evaluated by radiology. The statistical analysis was performed with the SPSS 22.0 and OpenEpi softwares.Results:84 patients were included, 60 men and 24 women, with a mean age of 59 years (± SD 13). 51.2% had lumbar syndesmophytes. The prevalence of fractures was 13.7%, 95 CI (7.8-22.9). 51.2% were treated with NSAIDs, and 48.8% with biological drugs. The evolution of axSpA was > 10 years in 65.5%. The mean scores of BASDAI and BASFI were 3.7 and 4.3 respectively (± SD 2.2 and 2.3). The mean CRP value was 8.5 mg / L (± SD 8.4), ESR 12.2 mm / h (± SD 11.4) and 1.25-OHD 27.9 ng / dL (± SD 13.6).According to the lumbar and femoral T Score, 9.5% and 15.5% of the patients were in the range of osteoporosis respectively.19% patients had a low TBS value (≤1.23).Regarding the influence of syndesmophytes on TBS and BMD values, we found significant differences in lumbar spine BMD (p = 0.01) but not in total hip and femoral neck BMD (p = 0.2 and 0.3 respectively) nor in the TBS (p = 0.1).Regarding the correlation of TBS and BMD values of the spine, no correlation was observed in patients with syndesmophytes, while a moderate correlation (r = 0.4, p = 0.02) was observed in patients without syndesmophytes.In the univariate analysis, the factors related to the presence of vertebral fracture were age, female sex, absolute BMD values in the lumbar spine and total hip, and TBS values. No relationship was found with the rest of the variables. In the multivariate analysis, only the TBS showed a significant association with the presence of fractures (p =0.02).Regarding the predictive capacity of fractures, TBS showed a higher sensitivity than that of BMD (55.6% versus 18.2% and 30% of BMD in the spine and hip respectively), being the specificity comparable (85.3% versus 91.3% and 85.1% of BMD in column and hip respectively).Conclusion:the prevalence of fractures was 13.7% among the patients studied, 95 CI (7.8-22.9). The presence of syndesmophytes influenced the values of lumbar BMD but not the hip BMD or those of the TBS. We found a correlation between the values of BMD of the spine and TBS only in patients who did not have syndesmophytes. Only TBS values were significantly related to the presence of fractures in the multivariate analysis. TBS showed greater sensitivity with similar specificity than BMD for the detection of vertebral fractures.Disclosure of Interests:Ana V Orenes Vera: None declared, L Montolio-Chiva: None declared, I Vázquez-Gómez: None declared, Eduardo Flores: None declared, Elia Valls-Pascual Grant/research support from: Roche, Novartis, and AbbVie, Speakers bureau: AbbVie, Lilly, Pfizer, MSD, Novartis, Janssen, Bristol Myers Squibb, UCB Pharma, À Martínez-Ferrer: None declared, Desamparados Ybañez: None declared, Luis García-Ferrer: None declared, María Vega-Martínez: None declared, Magdalena Graells-Ferrer: None declared, A Sendra-García: None declared, V Núñez-Monje: None declared, Inmaculada Torner Hernández: None declared, Juanjo J Alegre-Sancho Consultant of: UCB, Roche, Sanofi, Boehringer, Celltrion, Paid instructor for: GSK, Speakers bureau: MSD, GSK, Lilly, Sanofi, Roche, UCB, Actelion, Pfizer, Abbvie, Novartis

Denosumab-Induced Hypocalcemia and Hyperparathyroidism in de novo Kidney Transplant Recipients

2021 ◽  
pp. 1-9
Author(s):  
Giuseppe Cianciolo ◽  
Francesco Tondolo ◽  
Simona Barbuto ◽  
Francesca Iacovella ◽  
Guido Zavatta ◽  
...  
Keyword(s):  
Bone Mineral Density ◽  
Vitamin D ◽  
Kidney Transplantation ◽  
Kidney Transplant ◽  
Bone Disease ◽  
De Novo ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Mineral Density

<b><i>Introduction:</i></b> Denosumab represents a realistic treatment option to increase bone mineral density in kidney transplant recipients (KTRs). It is still unknown how and at what extent posttransplantation bone disease and graft function influence the effects of denosumab on mineral metabolism indexes. In this study, we analyze risk factors of hypocalcemia and parathyroid hormone (PTH) increase after denosumab administration in eighteen de novo KTRs and its management before and after this treatment. <b><i>Methods:</i></b> We conducted a monocentric, observational, prospective study on de novo KTRs. All KTRs enrolled received a single 60 mg subcutaneous dose of denosumab every 6 months. Before kidney transplantation, no patients were treated with calcio-mimetic. After kidney transplantation and before antiresorptive therapy, no patients were treated with calcio-mimetic drugs and/or vitamin D receptor agonists, while all patients received nutritional vitamin D supplementation (from 1,000 IU to 1,500 IU daily). <b><i>Results:</i></b> Hypocalcemia was related to the degree of lumbar osteoporosis (<i>p</i> = 0.047); the increase in the PTH level was correlated to baseline bone turnover markers (bone alkaline phosphatase, serum osteocalcin, and β-C-terminal telopeptide), the 25 OH status, and eGFR. The introduction of calcitriol, after the PTH increase, in addition to cholecalciferol was necessary to ensure an adequate control of serum calcium and PTH during a follow-up of 15 months. Following the treatment with denosumab, it was observed an improvement of areal bone mineral density both at lumbar and femoral sites with a mean percentual increase of 1.74% and 0.25%, respectively. <b><i>Conclusions:</i></b> Denosumab is an effective treatment for bone disease in KTRs. In our study, the increase in PTH is not a transient event but prolonged throughout the follow-up period and requires continuous supplementation therapy with calcitriol.

Trabecular bone score in kidney transplant recipients

2015 ◽  
Vol 27 (3) ◽  
pp. 1115-1121 ◽  
Author(s):  
K. L. Naylor ◽  
L. M. Lix ◽  
D. Hans ◽  
A. X. Garg ◽  
D. N. Rush ◽  
...  
Keyword(s):  
Trabecular Bone ◽  
Kidney Transplant ◽  
Trabecular Bone Score ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients

scholarly journals Standard induction with basiliximab versus no induction in low immunological risk kidney transplant recipients: study protocol for a randomized controlled trial

Trials ◽  
2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Aziza Ajlan ◽  
Hassan Aleid ◽  
Tariq Zulfiquar Ali ◽  
Hala Joharji ◽  
Khalid Almeshari ◽  
...  
Keyword(s):  
Kidney Transplant ◽  
De Novo ◽  
Controlled Trial ◽  
Controlled Clinical Trial ◽  
First Year ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Double Blind ◽  
Donor Specific Antibodies

Abstract Background Induction therapy with IL-2 receptor antagonist (IL2-RA) is recommended as a first-line agent in low immunological risk kidney transplant recipients. However, the role of IL2-RA in the setting of tacrolimus-based immunosuppression has not been fully investigated. Aims To compare different induction therapeutic strategies with 2 doses of basiliximab vs. no induction in low immunologic risk kidney transplant recipients as per KFSHRC protocol. Methods Prospective, randomized, double blind, non-inferiority, controlled clinical trial Expected outcomes 1. Primary outcomes: Biopsy-proven acute rejection within first year following transplant 2. Secondary outcomes: a. Patient and graft survival at 1 year b. eGFR at 6 months and at 12 months c. Emergence of de novo donor-specific antibodies (DSAs) Trial registration The study has been prospectively registered at clinicaltrials.gov (NTC: 04404127). Registered on 27 May 2020.

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