Monthly treatment with romosozumab for 1 year increases bone mineral at the hip, but not the knee, in women with chronic spinal cord injury

JBMR Plus, 2024 · DOI: https://doi.org/10.1093/jbmrpl/ziae077 · Published: June 7, 2024

Endocrinology Rehabilitation Musculoskeletal Medicine

Simple Explanation

Spinal cord injury (SCI) is associated with profound bone loss and an increased risk of fracture, particularly at the knee. Romosozumab is a novel pharmaceutical treatment for PMO. The purpose of this research was to investigate the effects of monthly treatment with romosozumab on BMD and strength in 12 women with chronic SCI. Therefore, while romosozumab treatment in chronic SCI shows promise for reducing fracture risk at the hip, fracture risk at the knee is unlikely to be affected.

Study Duration

1 year

Participants

12 female participants with chronic SCI

Evidence Level

Clinical Trial

Key Findings

1
After 12 mo of treatment, areal BMD at the lumbar spine and total hip were signiﬁcantly increased with median changes of 10.2% (IQR: 8.3–15.2%, p<.001) and 4.2% (IQR: 3.4–7.7%, p = .009), respectively.
2
Improvements at the hip were primarily due to increases in trabecular, not cortical, bone and effects were sufﬁcient to signiﬁcantly increase FE-predicted strength by 20.3% (IQR: 9.5–37.0%, p = .004).
3
Treatment with romosozumab did not lead to any signiﬁcant improvement in bone mineral at the distal femur or proximal tibia.

Research Summary

One year of romosozumab treatment in women with chronic SCI increased DXA-derived aBMD at the lumbar spine and hip. These results were congruent with CT results at the hip, which indicated increases in trabecular, but not cortical, bone mineral, as well as significant improvements in proximal femoral strength predicted with FE modeling. Therefore, our study provides promising results for romosozumab treatment to improve bone mineral and reduce fracture risk at the hip, but not the knee, in this population.

Practical Implications

Hip Fracture Risk Reduction

Romosozumab treatment shows promise for reducing fracture risk at the hip in women with chronic SCI.

Ineffective for Knee Fracture

Romosozumab treatment is unlikely to reduce fracture risk at the knee in women with chronic SCI.

Trabecular Bone Improvement

Romosozumab primarily improves trabecular bone at the hip, which contributes to increased bone strength.

Study Limitations

1
Small sample size of 12 women with chronic SCI
2
Unable to include measures of bone turnover markers
3
This was not a randomized controlled trial as all participants received treatment

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