CalciumNEW2026-10

Efficacy of sequential romosozumab-denosumab therapy in patients on hemodialysis: association with bone mineral density improvement and TRACP-5b rebound.

Kiyosumi Rie, Koinuma Kana, Nodaira Yuka, Ikeda Naofumi — Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA

Summary

This study explored a new treatment approach for osteoporosis in people undergoing kidney dialysis, who are at high risk for bone fractures. Researchers found that using two specific medications, romosozumab followed by denosumab, helped improve bone strength. The timing of switching between these medications was important for maintaining these benefits.

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Key points

People on kidney dialysis face a higher risk of bone fractures due to osteoporosis.
A specific sequence of two medications, romosozumab then denosumab, improved bone density in these patients.
Careful management of the transition time between these two drugs is important to maintain bone health benefits.
This treatment approach shows promise for strengthening bones in high-risk dialysis patients.

What the study looked at

What question did the study ask? This study investigated whether a specific sequence of two medications could effectively treat osteoporosis in patients undergoing kidney dialysis, a group known to have a higher risk of bone fractures. They also wanted to understand if the timing of switching between these medications affected the treatment's success. How was it studied? Researchers conducted a retrospective study, looking back at the medical records of 34 dialysis patients. These patients received romosozumab for one year, followed by denosumab for another year. The study measured changes in bone mineral density (a measure of bone strength) and bone turnover markers (indicators of bone breakdown and formation) over time. They also analyzed how the interval between the two drugs related to bone marker changes. What did it find? The study found that this sequential treatment significantly improved bone mineral density in the spine and hip. It also showed positive changes in bone turnover markers, indicating healthier bone metabolism. Importantly, the researchers observed that a shorter, more timely transition between the two medications was crucial to prevent a rebound in bone breakdown, suggesting that careful management of the switch is key to maintaining the benefits.

Dietary takeaway

While this study focuses on specific medications for a high-risk group, it underscores the general importance of bone health. For the general public, maintaining strong bones relies on adequate calcium intake from foods like dairy products, leafy greens, and fortified foods, alongside vitamin D. Remember, this research specifically examined drug therapy for dialysis patients, and one study alone cannot provide definitive dietary recommendations for everyone.

Abstract

UNLABELLED: Osteoporosis treatment in patients undergoing maintenance dialysis remains to be established. Sequential romosozumab-to-denosumab therapy improved bone mineral density and suppressed bone turnover. Shorter transition periods were associated with reduced TRACP-5b rebound, highlighting the importance of transition management and suggesting this approach as a promising option for this high-risk population. PURPOSE: Patients on dialysis have a higher risk of fractures than the general population. However, osteoporosis treatment in patients on dialysis has not been established. We aimed to evaluate the efficacy of sequential therapy with romosozumab followed by denosumab and examine the clinical impact of the transition period between these agents. METHODS: In this retrospective multicenter cohort study, 34 patients on maintenance dialysis received romosozumab for 12 months followed by denosumab for 12 months. Endpoints included lumbar spine and femoral neck bone mineral density and bone turnover marker levels. The transition period between the two agents was analyzed in relation to rebound of tartrate-resistant acid phosphatase 5b level. RESULTS: Sequential therapy improved bone mineral density (lumbar spine: 0.797-0.997 g/cm²; femoral neck: 0.490-0.537 g/cm² p < 0.001) and the corresponding T-scores (lumbar spine: -2.1 to -0.9; femoral neck: -3.0 to -2.7; p < 0.001). Bone turnover marker levels also improved, including a marked decrease in tartrate-resistant acid phosphatase 5b levels. However, as both agents may induce hypocalcemia, we implemented an internal protocol involving strict monitoring of parathyroid hormone and serum calcium levels. Consequently, some patients required a longer interval before transitioning from romosozumab to denosumab. A longer transition period was associated with greater rebound of tartrate-resistant acid phosphatase 5b level, particularly when the interval exceeded 4 months. CONCLUSION: The sequential therapy was associated with significant improvements in bone mineral density and bone turnover marker levels among patients on dialysis. Timely transition between agents appears critical to maintain suppression of bone resorption.

View on PubMed →DOI: 10.1007/s00198-026-08240-x