Denosumab treatment for osteopenia or osteoporosis in heart transplant recipients: Effects and safety

Abstract

Background: Osteoporosis is a prevalent complication in heart transplant population. Denosumab is a monoclonal antibody that inhibits bone resorption approved for the treatment of corticosteroid-induced osteoporosis and potentially useful in heart transplant recipients. Objective: To describe the metabolic and densitometric effects of denosumab in these patients, as well as the adverse effects observed. Methods: We performed a study of 9 transplant patients between 2014 and 2019 who were treated with denosumab for osteopenia or osteoporosis. All patients received postoperative calcium and vitamin D supplements. We measured the changes in densitometric and metabolic variables and compared them by Student's t-test. Results: After therapy, bone mineral density (BMD) and Tscore at lumbar spine improved a mean of 0.0458 and 0.5000, respectively (p < 0.05). The mean increase of BMD was 6.09% at lumbar spine and 7.84% at femoral neck. There was a case of abrupt decrease of BMD at total hip. A decrease in magnesium levels was observed after a dose of denosumab (p < 0.05), which included 1 case of hypomagnesemia. There were 2 cases of hypophosphatemia, and none of hypocalcaemia. 77.78% of the patients had infections, one of them serious. Conclusion: Denosumab was shown to improve BMD at lumbar spine and could be a valid alternative for the treatment of osteoporosis in heart transplant patients. The risk of hypocalcaemia could be minimized with calcium adjustment prior to starting treatment. More studies are needed to assess its effects and the risk of infections.

Keywords

• Heart transplantation
• Metabolic bone diseases
• Osteoporosis
• Bone density conservation agents
• Denosumab