Miyaoka Daichi, Imanishi Yasuo, Kato Eiko, Toi Norikazu, Nagata Yuki, Kurajoh Masafumi, Yamada Shinsuke, Inaba Masaaki, Emoto Masanori
Department of Metabolism, Endocrinology and Molecular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan.
Endocrine. 2020 Sep;69(3):642-649. doi: 10.1007/s12020-020-02401-6. Epub 2020 Jul 3.
To evaluate the effects of denosumab (Dmb) on calcium, renal, and bone involvement in osteoporotic patients with primary hyperparathyroidism (PHPT) and compare with those who underwent a parathyroidectomy (PTX) procedure.
This retrospective, longitudinal study included patients treated with Dmb (60 mg) once every 6 months (n = 19) and those who successfully underwent a PTX procedure (n = 19) corrected calcium (cCa), eGFR, bone mineral density (BMD) in the lumbar spine (LS), total hip (TH), and femoral neck (FN) and LS-trabecular bone score (TBS) changes at 1 year after beginning Dmb or undergoing PTX were measured.
Dmb group had older age, and showed milder disease activity and lower eGFR as compared with PTX group. In PTX group, cCa and eGFR were significantly decreased following surgery, while those were stable in Dmb group. There were significant increases in LS, TH, and FN-BMD in both Dmb (LS: 6.0 ± 0.8%, TH: 3.7 ± 1.0%, FN: 4.3 ± 1.5%) and PTX (LS: 11.2 ± 1.5%, TH: 7.5 ± 1.5%, FN: 7.9 ± 2.1%) groups. In Dmb group, LS-TBS was significantly improved by 3.0 ± 1.0%, while TBS change in PTX group approached significance (2.8 ± 1.5%). Percent change in TH-BMD was significantly correlated with baseline tartrate-resistant acid phosphatase-5b (TRACP-5b) in both groups.
Dmb treatment not only increased BMD, dependent on bone turnover status, the same as PTX, but also improved LS-TBS. In addition, it did not decrease the level of eGFR, whereas PTX did. These results suggest that Dmb treatment help in the clinical management of osteoporotic patients with PHPT who do not undergo surgery as alternative to PTX.
评估地诺单抗（Dmb）对原发性甲状旁腺功能亢进症（PHPT）骨质疏松患者钙、肾脏及骨骼受累情况的影响，并与接受甲状旁腺切除术（PTX）的患者进行比较。
这项回顾性纵向研究纳入了每6个月接受一次Dmb（60mg）治疗的患者（n = 19）以及成功接受PTX手术的患者（n = 19），测量开始使用Dmb或接受PTX后1年时的校正钙（cCa）、估算肾小球滤过率（eGFR）、腰椎（LS）、全髋（TH）和股骨颈（FN）的骨密度（BMD）以及LS骨小梁评分（TBS）的变化。
Dmb组年龄较大，与PTX组相比疾病活动度较轻且eGFR较低。在PTX组中，术后cCa和eGFR显著降低，而在Dmb组中则保持稳定。Dmb组（LS：6.0±0.8%，TH：3.7±1.0%，FN：4.3±1.5%）和PTX组（LS：11.2±1.5%，TH：7.5±1.5%，FN：7.9±2.1%）的LS、TH和FN - BMD均显著增加。在Dmb组中，LS - TBS显著改善了3.0±1.0%，而PTX组的TBS变化接近显著水平（2.8±1.5%）。两组中TH - BMD的百分比变化均与基线抗酒石酸酸性磷酸酶 - 5b（TRACP - 5b）显著相关。
Dmb治疗不仅与PTX一样，根据骨转换状态增加骨密度，还改善了LS - TBS。此外，它不会降低eGFR水平，而PTX会。这些结果表明，Dmb治疗有助于不接受手术的PHPT骨质疏松患者的临床管理，可作为PTX的替代方案。
