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Denosumab improves trabecular bone score in relationship with decrease in fracture risk of women exposed to aromatase inhibitors

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A Correction to this article was published on 09 October 2023

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Abstract

Purpose

Trabecular bone score (TBS) is a gray-level textural metric that has shown to correlate with risk of fractures in several forms of osteoporosis. The value of TBS in predicting fractures and the effects of bone-active drugs on TBS in aromatase inhibitors (AIs)-induced osteoporosis are still largely unknown. The primary objective of this retrospective study was to assess the effects of denosumab and bisphosphonates (BPs) on TBS and vertebral fractures (VFs) in women exposed to AIs.

Methods

241 consecutive women (median age 58 years) with early breast cancer undergoing treatment with AIs were evaluated for TBS, bone mineral density (BMD) and morphometric VFs at baseline and after 18–24 months of follow-up. During the study period, 139 women (57.7%) received denosumab 60 mg every 6 months, 53 (22.0%) BPs, whereas 49 women (20.3%) were not treated with bone-active drugs.

Results

Denosumab significantly increased TBS values (from 1.270 to 1.323; P < 0.001) accompanied by a significant decrease in risk of VFs (odds ratio 0.282; P = 0.021). During treatment with BPs, TBS did not significantly change (P = 0.849) and incidence of VFs was not significantly different from women untreated with bone-active drugs (P = 0.427). In the whole population, women with incident VFs showed higher decrease in TBS vs. non-fractured women (P = 0.003), without significant differences in changes of BMD at any skeletal site.

Conclusions

TBS variation predicts fracture risk in AIs treated women. Denosumab is effective to induce early increase of TBS and reduction in risk of VFs.

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Author notes

  1. Alfredo Berruti and Gherardo Mazziotti equally contributed and are the co-senior authors.

Authors and Affiliations

  1. Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, MI, Italy

    S. Antonini, M. F. Birtolo, N. L. Baruch, S. Jaafar, A. Ciafardini, A. Zambelli, A. G. Lania & G. Mazziotti

  2. Endocrinology, Diabetology and Andrology Unit, IRCCS Humanitas Research Hospital, Rozzano, MI, Italy

    S. Antonini, M. F. Birtolo, F. Carrone, S. Jaafar, A. Ciafardini, A. G. Lania & G. Mazziotti

  3. Medical Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, ASST Spedali Civili of Brescia, Brescia, Italy

    R. Pedersini, D. Cosentini, M. Laganà & A. Berruti

  4. Cancer Center, IRCCS Humanitas Research Hospital, Rozzano, MI, Italy

    R. Torrisi & A. Zambelli

  5. Radiology Unit 2, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, ASST Spedali Civili of Brescia, Brescia, Italy

    D. Farina

  6. Department of Radiology, IRCCS Humanitas Research Hospital, Rozzano, MI, Italy

    L. Leonardi & L. Balzarini

  7. Endocrinology, Humanitas Gavazzeni-Castelli, Bergamo, Italy

    W. Vena & A. C. Bossi

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Conflict of interest

The authors declare the following competing financial interests: Dr Pedersini received consultancy fees from Roche, Novartis, Eli Lilly, Daiichi Sankyo, Gilead, Eisai, Accord, outside the submitted work; Dr. Torrisi received research grants from Pfizer, consultancy fees from MSD and lecture fees from Pfizer, Eli Lilly, EISAI and Genomic Health outside the submitted work; Dr. Vena received grants from IBSA Pharmaceutical outside the submitted work; Dr. Zambelli received consultancy fees from Roche, Novartis, Pfizer, Eli Lilly & Co., AstraZeneca, Genomic Health outside the submitted work; Dr. Bossi received research grants from Novo-Nordisk, Eli Lilly, Bayer, Sanofi Italia and advisory board and consultancy fees from MSD, Alfasigma, Boehringer Ingelheim, Astra Zeneca, Mundipharma Italia, Pfizer outside the submitted work; Dr. Lania received grants from Pfizer and consultancy fees from Ipsen, outside the submitted work; Dr. Berruti reports receiving grants and personal fees from Janssen Cilag, grants and personal fees from Astellas, and personal fees from Bayer outside the submitted work; Dr. Mazziotti received consultancy fees from Novartis, Ipsen, Eli Lilly and lecture fees from Amgen and Abiogen, outside the submitted work.

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Antonini, S., Pedersini, R., Birtolo, M.F. et al. Denosumab improves trabecular bone score in relationship with decrease in fracture risk of women exposed to aromatase inhibitors. J Endocrinol Invest 47, 433–442 (2024). https://doi.org/10.1007/s40618-023-02174-5

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  • Issue Date:

  • DOI: https://doi.org/10.1007/s40618-023-02174-5

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