Reid et al.: Effects of denosumab on bone histomorphometry: The freedom and stand studies

Reid, I; Miller, P; Brown, J; Kendler, D; Fahrleitner-Pammer, A; Valter, I; Maasalu, K; Bolognese, M; Woodson, G; Bone, H; Ding, B; Wagman, R; Martin, JS; Ominsky, M; Dempster, D; on behalf of the Denosumab Phase 3 Bone Histology Study Group.
Effects of denosumab on bone histomorphometry: The freedom and stand studies.
J Bone Miner Res. 2010; PUBMED full text full text MUG-login

Denosumab, a human monoclonal antibody against RANKL, reversibly inhibits osteoclast-mediated bone resorption and has been developed for use in osteoporosis. Its effects on bone histomorphometry have not been described previously. Iliac crest bone biopsies were collected at 24 and/or 36 months from osteoporotic postmenopausal women in the FREEDOM study (45 women receiving placebo and 47 denosumab), and at 12 months from postmenopausal women previously treated with alendronate in the STAND study (21 continuing alendronate and 15 changed to denosumab at trial entry). Qualitative histological evaluation of biopsies was unremarkable. In the FREEDOM study, median eroded surface was reduced by >80% and osteoclasts were absent from >50% of biopsies in the denosumab group. Double labeling in trabecular bone was observed in 94% of placebo bones, and in 19% of those treated with denosumab. Median bone formation rate was reduced by 97%. Among denosumab-treated subjects, those with double labels and those with absent labels had similar levels of biochemical markers of bone turnover. In the STAND trial, indices of bone turnover tended to be lower in the denosumab group, compared with alendronate. Double labeling in trabecular bone was seen in 20% of the denosumab biopsies and in 90% of alendronate samples. Denosumab markedly reduces bone turnover and also reduces fracture numbers. Longer follow-up is necessary to determine for how long such low turnover is safe. (c) 2010 American Society for Bone and Mineral Research.