Assessment the efficacy and safety of denosumab use for treatment of osteoporosis in hemodialysis patients

Introduction: Osteoporosis is common in patients with chronic kidney disease (CKD) that could direct to metabolic abnormalities and accelerate bone loss. The administration of bisphosphonates for the management of osteoporosis is contraindicated in cases with severe kidney impairment. Objectives: In the current investigation, we assess the effectiveness and safety of denosumab administration for the therapy of osteoporosis in hemodialysis (HD) individuals. Patients and Methods: Seventy-four HD cases with osteoporosis who were received denosumab were assessed retrospectively. All individuals received supplemental vitamin D. Serum calcium, phosphate, parathyroid hormone (PTH), and alkaline phosphatase (ALP) had been measured every three months. Denosumab efficacy was measured by assessing the alterations of bone mineral density (BMD) and plasma ALP. Results: The mean values of T-score of the spine and hips in HD patients after treatment with denosumab when compared with before treatment was not statistically significant (P=0.7019 and P=0.494 respectively). There was a low mean serum ALP in the HD patients after treatment with denosumab when compared with before treatment, but not statistically significant (P=0.0625). Plasma calcium concentration decreased shortly after the injection of denosumab however returned within fourteen days. Supplementary vitamin D (1.0 to 1.5 μg/day) looked to prevent hypocalcemia and support long treatment with denosumab. Conclusion: Our study suggests that denosumab is not associated with increases in the BMD of the spine and hip in patients with CKD on HD and hypocalcemia is a concern complication.