Changes in circulating levels of calcium and bone metabolism biochemical markers in patients receiving denosumab treatment

doi:10.12122/j.issn.1673-4254.2025.04.11

Abstract

Abstract:

Objective To investigate the changes in blood levels of calcium and bone metabolism biochemical markers in patients with primary osteoporosis receiving treatment with denosumab. Methods Seventy-three patients with primary osteoporosis treated in our Department between December, 2021 and December 2023 were enrolled. All the patients were treated with calcium supplements, vitamin D and calcitriol in addition to regular denosumab treatment every 6 months. Blood calcium, parathyroid hormone (PTH), osteocalcin (OC), type I procollagen amino-terminal propeptide (PINP), and type I collagen carboxy-terminal telopeptide β special sequence (β‑CTX) data before and at 3, 6, 9, and 12 months after the first treatment were collected from each patient. Results Three months after the first denosumab treatment, the bone turnover markers (BTMs) OC, PINP, and β-CTX were significantly decreased compared to their baseline levels by 39.5% (P<0.001), 56.2% (P<0.001), and 81.8% (P<0.001), respectively. At 6, 9, and 12 months of treatment, OC, PINP, and β-CTX remained significantly lower than their baseline levels (P<0.001). Blood calcium level was decreased (P<0.05) and PTH level increased (P<0.05) significantly in these patients at months of denosumab treatment, but their levels were comparable to the baseline levels at 6, 9, and 12 months of the treatment (P>0.05). Conclusion Denosumab can suppress BTMs and has a good therapeutic effect in patients with primary osteoporosis, but reduction of blood calcium and elevation of PTH levels can occur during the first 3 months in spite of calcium supplementation. Blood calcium and PTH levels can recover the baseline levels as the treatment extended, suggesting the importance of monitoring blood calcium and PTH levels during denosumab treatment.

Key words: denosumab, osteoporosis, circulating calcium, parathyroid hormone, bone turnover markers

Yuancheng CHEN, Wen WU, Ling XU, Haiou DENG, Ruixue WANG, Qianwen HUANG, Liping XUAN, Xueying CHEN, Ximei ZHI. Changes in circulating levels of calcium and bone metabolism biochemical markers in patients receiving denosumab treatment[J]. Journal of Southern Medical University, 2025, 45(4): 760-764.

Figures/Tables 5

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Clinical characteristics	Baseline	3 months	t	P
Blood calcium (mmol/L)	2.349±0.101	2.300±0.116	2.456	0.020
PTH (pg/mL)	44.066±14.920	57.616±35.192	-2.459	0.022
OC (ng/mL)	18.023±8.014	10.901±3.984	5.879	<0.001
PⅠNP (ng/mL)	52.476±27.578	22.980±19.681	5.814	<0.001
β-CTX (ng/mL)	0.473±0.234	0.086±0.086	8.017	<0.001

Clinical characteristics	Baseline	3 months	t	P
Blood calcium (mmol/L)	2.349±0.101	2.300±0.116	2.456	0.020
PTH (pg/mL)	44.066±14.920	57.616±35.192	-2.459	0.022
OC (ng/mL)	18.023±8.014	10.901±3.984	5.879	<0.001
PⅠNP (ng/mL)	52.476±27.578	22.980±19.681	5.814	<0.001
β-CTX (ng/mL)	0.473±0.234	0.086±0.086	8.017	<0.001

Clinical characteristics	Baseline	6 months	t	P
Blood calcium (mmol/L)	2.366±0.983	2.368±0.100	-0.171	0.865
PTH (pg/mL)	40.802±17.194	44.467±18.090	-1.843	0.071
OC (ng/mL)	17.563±7.868	9.208±3.019	9.329	<0.001
PⅠNP (ng/mL)	50.260±30.041	20.274±15.395	7.665	<0.001
β-CTX (ng/mL)	0.423±0.238	0.107±0.830	9.461	<0.001

Clinical characteristics	Baseline	6 months	t	P
Blood calcium (mmol/L)	2.366±0.983	2.368±0.100	-0.171	0.865
PTH (pg/mL)	40.802±17.194	44.467±18.090	-1.843	0.071
OC (ng/mL)	17.563±7.868	9.208±3.019	9.329	<0.001
PⅠNP (ng/mL)	50.260±30.041	20.274±15.395	7.665	<0.001
β-CTX (ng/mL)	0.423±0.238	0.107±0.830	9.461	<0.001

Clinical characteristics	Baseline	9 months	t	P
Blood calcium (mmol/L)	2.373±0.101	2.350±0.144	0.632	0.537
PTH (pg/mL)	40.892±15.590	44.801±24.792	-1.009	0.329
OC (ng/mL)	15.782±5.336	8.049±2.390	6.374	<0.001
PⅠNP (ng/mL)	42.189±4.17	15.669±10.296	5.707	<0.001
β-CTX (ng/mL)	0.376±0.194	0.061±0.042	6.535	<0.001