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There was a good practical update today on osteoporosis (OP) focusing on the usual topics of drug holidays, atypical femur fractures, denosumab and up-and-coming treatments. Several points were worth passing on.
The issue of combining denosumab with other biologics was discussed. There are data from oncology in patients undergoing chemotherapy for breast cancer using much higher doses of denosumab than we use for OP, with no increase in infection rates. A trial published in 2015 by Curtis et al showed no difference in infection rates in patients on biologics who were treated for OP with either denusomab or zoledronic acid. I suspect most of us combine denosumab with biologics quite frequently based on the feelings of local opinion leaders, but the data do provide reassurance. The presenter, Dr. Deal, also felt that denosumab was safe to use in stage 4 CRF, with vigilance for hypocalcemia. This generated some discussion during the question period since our nephrology colleagues may not feel the same way.
Two exciting new agents were presented. Romosozumab, a monoclonal antibody against sclerostin, looks promising. It increases bone formation but also decreases bone resorption, building stronger bone than teriparatide. Watch for it in 2017, probably it will be approved for a year of therapy followed by switching to another agent.
There was also a bit of buzz about abaloparatide. It was also presented during the Year in Review on day 1 as a therapy that holds promise. It is a monthly SC injection that binds to PTH-1 receptor in a different way than teriparatide, leading to less hypercalcemia and a greater increase in bone mass than teriparatide. Stay tuned for more on that one.
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About the Author
Dr. Shelly Dunne
Dr. Shelley Dunne is a graduate of Memorial University of Newfoundland School of Medicine. She completed her training in Internal Medicine and a fellowship in Rheumatology at the University of Toronto. She has been in private practice since 1998 and is currently a consulting rheumatologist at the Toronto East General Hospital.
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