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Title: Differing effects of denosumab and alendronate on cortical and trabecular bone.
Austin Authors: Zebaze, Roger M D;Libanati, Cesar;Austin, Matthew;Ghasem-Zadeh, Ali ;Hanley, David A;Zanchetta, Jose R;Thomas, Thierry;Boutroy, Stephanie;Bogado, Cesar E;Bilezikian, John P;Seeman, Ego 
Affiliation: Amgen Inc., ThoUSAnd Oaks, CA, USA
University of Calgary, Calgary, Canada
Austin Health, University of Melbourne, Melbourne, Australia
College of Physicians and Surgeons, Columbia University, New York, NY, USA
INSERM U1059, University Hospital of St-Etienne, St-Etienne, France
INSERM U1033, Université de Lyon, Lyon, France
Instituto de Investigaciones Metabolicas, Buenos Aires, Argentina
Issue Date: 22-Nov-2013
Publication information: Bone 2013; 59(): 173-9
Abstract: Vertebral fractures and trabecular bone loss are hallmarks of osteoporosis. However, 80% of fractures are non-vertebral and 70% of all bone loss is cortical and is produced by intracortical remodeling. The resulting cortical porosity increases bone fragility exponentially. Denosumab, a fully human anti-RANKL antibody, reduces the rate of bone remodeling more than alendronate. The aim of this study was to quantify the effects of denosumab and alendronate on cortical and trabecular bone. Postmenopausal women, mean age 61years (range 50 to 70), were randomized double blind to placebo (n=82), alendronate 70mg weekly (n=82), or denosumab 60mg every 6months (n=83) for 12months. Porosity of the compact-appearing cortex (CC), outer and inner cortical transitional zones (OTZ, ITZ), and trabecular bone volume/total volume (BV/TV) of distal radius were quantified in vivo from high-resolution peripheral quantitative computed tomography scans. Denosumab reduced remodeling more rapidly and completely than alendronate, reduced porosity of the three cortical regions at 6months, more so by 12months relative to baseline and controls, and 1.5- to 2-fold more so than alendronate. The respective changes at 12months were [mean (95% CI)]; CC: -1.26% (-1.61, -0.91) versus -0.48% (-0.96, 0.00), p=0.012; OTZ: -1.97% (-2.37, -1.56) versus -0.81% (-1.45, -0.17), p=0.003; and ITZ: -1.17% (-1.38, -0.97) versus -0.78% (-1.04, -0.52), p=0.021. Alendronate reduced porosity of the three cortical regions at 6months relative to baseline and controls but further decreased porosity of only the ITZ at 12months. By 12months, CC porosity was no different than baseline or controls, OTZ porosity was reduced only relative to baseline, not controls, while ITZ porosity was reduced relative to baseline and 6months, but not controls. Each treatment increased trabecular BV/TV volume similarly: 0.25% (0.19, 0.30) versus 0.19% (0.13, 0.30), p=0.208. The greater reduction in cortical porosity by denosumab may be due to greater inhibition of intracortical remodeling. Head to head studies are needed to determine whether differences in porosity result in differing fracture outcomes.
Gov't Doc #: 24275677
DOI: 10.1016/j.bone.2013.11.016
Type: Journal Article
Subjects: Alendronate
Bone quality
Intracortical porosity
Antibodies, Monoclonal, Humanized.pharmacology
Bone and Bones.drug effects.radiography
Case-Control Studies
Collagen Type I.blood
Image Processing, Computer-Assisted
Middle Aged
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