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Effect of Twice‐Yearly Denosumab on Prevention of Bone Mineral Density Loss in De Novo Kidney Transplant Recipients: A Randomized Controlled Trial
Author(s) -
Bonani M.,
Frey D.,
Brockmann J.,
Fehr T.,
Mueller T. F.,
Saleh L.,
Eckardstein A.,
Graf N.,
Wüthrich R. P.
Publication year - 2016
Publication title -
american journal of transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.89
H-Index - 188
eISSN - 1600-6143
pISSN - 1600-6135
DOI - 10.1111/ajt.13692
Subject(s) - medicine , denosumab , bone mineral , n terminal telopeptide , urology , hazard ratio , randomized controlled trial , renal function , kidney transplantation , osteoporosis , confidence interval , transplantation , surgery , gastroenterology , osteocalcin , biochemistry , chemistry , alkaline phosphatase , enzyme
We conducted an open‐label, prospective, randomized trial to assess the efficacy and safety of RANKL inhibition with denosumab to prevent the loss of bone mineral density ( BMD ) in the first year after kidney transplantation. Ninety kidney transplant recipients were randomized 1:1 2 weeks after surgery to receive denosumab (60 mg at baseline and 6 months) or no treatment. After 12 months, total lumbar spine areal BMD ( aBMD ) increased by 4.6% (95% confidence interval [ CI ] 3.3–5.9%) in 46 patients in the denosumab group and decreased by −0.5% (95% CI −1.8% to 0.9%) in 44 patients in the control group (between‐group difference 5.1% [95% CI 3.1–7.0%], p < 0.0001). Denosumab also increased aBMD at the total hip by 1.9% (95% CI , 0.1–3.7%; p = 0.035) over that in the control group at 12 months. High‐resolution peripheral quantitative computed tomography in a subgroup of 24 patients showed that denosumab increased volumetric BMD at the distal tibia and radius (all p < 0.05). Biomarkers of bone turnover (C‐terminal telopeptide of type I collagen, procollagen type I N‐terminal propeptide) markedly decreased with denosumab (all p < 0.0001). Episodes of cystitis and asymptomatic hypocalcemia occurred more often with denosumab, whereas graft function, rate of rejections, and incidence of opportunistic infections were similar. In conclusion, denosumab increased BMD in the first year after kidney transplantation but was associated with more frequent episodes of urinary tract infection.