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Prolia Effective in Treating Osteoporosis in Transfusion Dependent Thalassemia

by Dr. C.H. Weaver M.D. 11/2018

According to a study published online in the journal Blood Advances patients with osteoporosis caused by transfusion-dependent thalassemia (TDT) experience an improvement in bone mineral density as well a pain reduction and improved quality of life if they receive a twice-yearly injection of Prolia (Denosumab).

Osteoporosis is a bone disease that affects 40 percent of people with TDT — an inherited congenital blood disorder that results in the decreased production of hemoglobin and red blood cells — and is one of the most prevalent comorbidities associated with the disorder. People with osteoporosis have porous, weak bones that are susceptible to fractures and often cause pain. Current standard therapy for people with TDT and osteoporosis is to administer intravenous bisphosphonate agents such as pamidronate or zoledronic acid.

It is believed that people with thalassemia and osteoporosis exhibit elevated levels of the osteoporosis regulator gene known as RANKL. Denosumab, delivered under the skin instead of intravenously, is an FDA-approved anti-RANKL therapy that is not yet approved for use in people with TDT-induced osteoporosis.

In the current study researchers evaluated Prolia in patients with TDT and osteoporosis. Overall 63 patients were treated with Prolia (n=32) or placebo (n=31) on days 0 and 180 over a period of 12 months and directly compared. Each patient was also provided with daily supplements of calcium and vitamin D throughout the study.

Each patient’s bone mineral density was measured in the L1–L4 lumbar spine, the wrist, and the femoral neck. Prolia treated patients experienced a 5.92 percent increase in lumbar bone density compared to a 2.92 percent increase in the placebo arm. Similarly, patients receiving denosumab lost less bone mineral density in their wrist while increasing density in the femoral neck. Prolia treated patients also reported a significant reduction in pain compared to those in the placebo arm.

According to senior study author Evangelos Terpos, MD, of the National and Kapodistrian University of Athens, Greece. “Not only is Prola associated with improved bone health and reduced pain, but its ease of administration may very well make this drug superior to bisphosphonates for the treatment of osteoporosis in patients with TDT and osteoporosis,”