King's College London, London, UK.
Canterbury Christ Church University, Kent, England.
Clin Rheumatol. 2021 Oct;40(10):4225-4232. doi: 10.1007/s10067-021-05757-w. Epub 2021 May 19.
The prevalence of sarcopenia with osteoporosis results in a higher risk of falling and fractures. It was noted that patients who had completed their planned 5-year denosumab therapy course as treatment for these conditions started to sustain falls.
To assess (a) whether denosumab has a unique dual effect on both bone and muscle in comparison to other anti-resorptive agents and (b) its effectiveness in the follow-up period post-treatment completion compared to other anti-resorptive agents.
One hundred thirty-five patients diagnosed to have postmenopausal/senile osteoporosis and who were prescribed denosumab were compared to a control group of 272 patients stratified into 2 subgroups - 136 prescribed alendronate and 136 prescribed zoledronate. All patients were assessed for: BMD (DXA), falls risk (FRAS), fracture risk (FRAX), and sarcopenia measures. All were re-assessed after 5 years of denosumab/alendronate therapy and 3 years of zoledronate and 1 year after stopping the osteoporosis therapy.
No significant baseline demographic differences between the 3 groups. On completion of the 5-year denosumab therapy, there was significant decrease in falls risk (P = 0.001) and significant improvements in all sarcopenia measures (P = 0.01). One-year post-discontinuation of denosumab, a significant worsening of both falls risk and sarcopenia measures (P = 0.01) noticed.
Denosumab displayed positive impact and significant improvements in BMD and sarcopenia measures. It also enhanced multidirectional agility as depicted by Timed Up and Go (TUG). Collectively, this would explain the reduction of falls risk which got worse on stopping the medication. Key points • The coexistence of osteoporosis and sarcopenia has been recently considered in some groups as a syndrome termed 'osteosarcopenia'. • Bone and muscle closely interact with each other not only anatomically, but also at the chemical and metabolic levels. • Denosumab displayed positive impact and significant improvements in all sarcopenia measures, and enhanced multidirectional agility with consequent reduction in falls risk. • Denosumab can be considered as a first osteoporosis therapeutic option in this group of patients presenting with osteosarcopenia manifestations.
患有骨质疏松症合并肌少症的患者跌倒和骨折的风险更高。有研究发现，接受地舒单抗治疗骨质疏松症的患者在完成 5 年计划疗程后开始出现跌倒。
评估（a）与其他抗吸收剂相比，地舒单抗是否对骨骼和肌肉具有独特的双重作用，以及（b）与其他抗吸收剂相比，其在治疗完成后的随访期内的有效性。
将 135 名被诊断患有绝经后/老年性骨质疏松症且接受地舒单抗治疗的患者与对照组（272 名患者分为 2 个亚组：136 名接受阿仑膦酸钠治疗，136 名接受唑来膦酸治疗）进行比较。所有患者均接受骨密度（DXA）、跌倒风险（FRAS）、骨折风险（FRAX）和肌少症评估。所有患者在接受地舒单抗/阿仑膦酸钠治疗 5 年后、唑来膦酸治疗 3 年后和停止骨质疏松症治疗 1 年后再次接受评估。
三组患者在基线人口统计学方面无显著差异。完成 5 年地舒单抗治疗后，跌倒风险显著降低（P=0.001），所有肌少症评估指标均显著改善（P=0.01）。停药 1 年后，跌倒风险和肌少症评估指标均显著恶化（P=0.01）。
地舒单抗对骨密度和肌少症评估指标均有积极影响，显著改善了这些指标。它还提高了 Timed Up and Go（TUG）测试所代表的多方向敏捷性。综上所述，这可以解释停药后跌倒风险增加的原因。
最近，一些研究小组将骨质疏松症和肌少症的共存视为一种称为“骨质疏松性肌少症”的综合征。
骨骼和肌肉不仅在解剖结构上相互作用，而且在化学和代谢水平上也相互作用。
地舒单抗对所有肌少症评估指标均有积极影响，显著改善了这些指标，并增强了多方向敏捷性，从而降低了跌倒风险。
对于有骨质疏松性肌少症表现的患者，地舒单抗可作为此类患者的一线骨质疏松症治疗选择。
