Cosman Felicia, Wang Zhenxun, Li Xiaodong, Cummings Steven R
Department of Medicine, Columbia University, New York, NY 10032, United States.
Amgen Inc., Thousand Oaks, CA 91230, United States.
J Bone Miner Res. 2025 Jun 3;40(6):766-772. doi: 10.1093/jbmr/zjaf014.
BMD levels achieved on osteoporosis treatment are predictive of subsequent fracture risk, and T-score >-2.5 has been proposed as a minimum treatment target for women with osteoporosis. Knowing the likelihood of attaining target T-scores with different medications for different baseline BMD levels can help determine appropriate initial treatment for individual patients. In this post hoc analysis, we estimated the probability of achieving a non-osteoporotic T-score (>-2.5 or ≥-2.0) at the TH or LS in postmenopausal women >60 yr old treated with denosumab for either 3 or 10 yr in the FREEDOM trial and its long-term extension. In women with baseline TH T-scores of -2.7, -3.0, and -3.5, the probabilities of achieving target T-scores >-2.5 with 3 yr of denosumab were 71%, 12%, and 0.1%, respectively. At LS, for baseline T-scores of -2.7, -3.0, and -3.5, the probabilities were 86%, 59%, and 11%, respectively. Longer treatment duration of up to 10 yr increased the probability of achieving target T-scores. The baseline T-scores that permitted at least 50% of women to achieve a target T-score >-2.5 were -2.8 at TH and -3.1 at LS after 3 yr and -3.0 at TH and -3.7 at LS after 10 yr of treatment. To achieve higher treatment targets (T-scores ≥ -2.0), overall probabilities were lower at both skeletal sites, particularly for TH, even with longer treatment duration. Our results demonstrate that the probability of achieving T-score targets with denosumab is dependent on baseline BMD, skeletal site, and treatment duration. Knowing the probability of achieving treatment targets for different baseline TH and LS T-scores can help determine whether denosumab is an appropriate first choice of treatment in individual patients.
骨质疏松症治疗所达到的骨密度水平可预测后续骨折风险，对于骨质疏松症女性，已提出将T值＞-2.5作为最低治疗目标。了解不同基线骨密度水平的女性使用不同药物达到目标T值的可能性，有助于为个体患者确定合适的初始治疗方案。在这项事后分析中，我们在FREEDOM试验及其长期延长期中，估计了60岁以上接受地诺单抗治疗3年或10年的绝经后女性在胸椎或腰椎达到非骨质疏松性T值（＞-2.5或≥-2.0）的概率。对于基线胸椎T值为-2.7、-3.0和-3.5的女性，使用地诺单抗3年达到目标T值＞-2.5的概率分别为71%、12%和0.1%。在腰椎，对于基线T值为-2.7、-3.0和-3.5的情况，概率分别为86%、59%和11%。长达10年的更长治疗时间增加了达到目标T值的概率。治疗3年后，允许至少50%的女性达到目标T值＞-2.5的基线T值在胸椎为-2.8，在腰椎为-3.1；治疗10年后，在胸椎为-3.0，在腰椎为-3.7。为了达到更高的治疗目标（T值≥-2.0），即使治疗时间更长，在两个骨骼部位的总体概率都更低,尤其是在胸椎。我们的结果表明，使用地诺单抗达到T值目标的概率取决于基线骨密度、骨骼部位和治疗时间。了解不同基线胸椎和腰椎T值达到治疗目标的概率，有助于确定地诺单抗是否是个体患者合适的首选治疗药物。
