Denosumab cuts risk of vertebral fractures in osteoporotics with diabetes

Denosumab is protective against vertebral fractures among osteoporotic people with diabetes, reports a recent meta-analysis.

Conducting a posthoc analysis of the FREEDOM study, researchers evaluated 508 diabetics who were on denosumab medication (n=266; mean age, 73.5±5.1 years) or who were given placebo (n=242; mean age, 73.5±5.0 years). Outcomes were treatment effects on bone mass density (BMD) and the risk of developing vertebral and nonvertebral factures.

BMD at the lumbar spine increased by 8.6 percent in the denosumab group over the 3-year study period. Placebo comparators, on the other hand, saw only a 1.9-percent increase during the same time span (between-group difference: p<0.05). Similar stronger improvements were observed at the femoral neck (4.2 percent vs –0.8 percent) and for the total hip (4.2 percent vs –1.9 percent; p<0.05 for both).

Notably, the effect of denosumab on BMD was independent of diabetes. In those without diabetes, the treatment resulted in significantly better BMD at all three sites over 3 years.

These BMD differences corresponded with reductions in the likelihood of sustaining vertebral fracture risks in diabetic denosumab patients (1.6 percent vs 8.0 percent; risk ratio, 0.20, 95 percent confidence interval [CI], 0.07–0.61; p=0.001). In contrast, these patients suffered from a higher risk of nonvertebral fractures (hazard ratio, 1.94, 95 percent CI, 1.00–3.77; p=0.046).

“In general, continuous BMD increases and sustained low rates of new vertebral and nonvertebral fractures were observed in subjects with diabetes in both long-term denosumab and crossover denosumab groups,” researchers said.