Comparison of proximal femur and vertebral body strength improvements in the FREEDOM trial using an alternative finite element methodology

Journal article


Zysset, Philippe, Pahr, Dieter, Engelke, Klaus, Genant, Harry K., McClung, Michael R., Kendler, David L., Recknor, Christopher, Kinzl, Michael, Schwiedrzik, Jakob, Museyko, Oleg, Wang, Andrea and Libanati, Cesar. (2015). Comparison of proximal femur and vertebral body strength improvements in the FREEDOM trial using an alternative finite element methodology. Bone. 81(December), pp. 122 - 130. https://doi.org/10.1016/j.bone.2015.06.025
AuthorsZysset, Philippe, Pahr, Dieter, Engelke, Klaus, Genant, Harry K., McClung, Michael R., Kendler, David L., Recknor, Christopher, Kinzl, Michael, Schwiedrzik, Jakob, Museyko, Oleg, Wang, Andrea and Libanati, Cesar
Abstract

Denosumab reduced the incidence of new fractures in postmenopausal women with osteoporosis by 68% at the spine and 40% at the hip over 36 months compared with placebo in the FREEDOM study. This efficacy was supported by improvements from baseline in vertebral (18.2%) strength in axial compression and femoral (8.6%) strength in sideways fall configuration at 36 months, estimated in Newtons by an established voxel-based finite element (FE) methodology. Since FE analyses rely on the choice of meshes, material properties, and boundary conditions, the aim of this study was to independently confirm and compare the effects of denosumab on vertebral and femoral strength during the FREEDOM trial using an alternative smooth FE methodology. Unlike the previous FE study, effects on femoral strength in physiological stance configuration were also examined. QCT data for the proximal femur and two lumbar vertebrae were analyzed by smooth FE methodology at baseline, 12, 24, and 36 months for 51 treated (denosumab) and 47 control (placebo) subjects. QCT images were segmented and converted into smooth FE models to compute bone strength. L1 and L2 vertebral bodies were virtually loaded in axial compression and the proximal femora in both fall and stance configurations. Denosumab increased vertebral body strength by 10.8%, 14.0%, and 17.4% from baseline at 12, 24, and 36 months, respectively (p < 0.0001). Denosumab also increased femoral strength in the fall configuration by 4.3%, 5.1%, and 7.2% from baseline at 12, 24, and 36 months, respectively (p < 0.0001). Similar improvements were observed in the stance configuration with increases of 4.2%, 5.2%, and 5.2% from baseline (p ≤ 0.0007). Differences between the increasing strengths with denosumab and the decreasing strengths with placebo were significant starting at 12 months (vertebral and femoral fall) or 24 months (femoral stance). Using an alternative smooth FE methodology, we confirmed the significant improvements in vertebral body and proximal femur strength previously observed with denosumab. Estimated increases in strength with denosumab and decreases with placebo were highly consistent between both FE techniques.

Keywordsdenosumab; proximal femur strength; vertebral body strength; FEA; QCT
Year2015
JournalBone
Journal citation81 (December), pp. 122 - 130
PublisherElsevier Inc.
ISSN8756-3282
Digital Object Identifier (DOI)https://doi.org/10.1016/j.bone.2015.06.025
Page range122 - 130
Research GroupInstitute for Health and Ageing
Publisher's version
File Access Level
Controlled
Place of publicationNetherlands
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Cosman, F., Gilchrist, N., McClung, Michael R., Foldes, J., de Villiers, T., Santora, A., Leung, A. T., Samanta, S., Heyden, N., McGinnis, J.P., Rosenberg, E. and Denker, A.E.. (2016). A phase 2 study of MK-5442, a calcium-sensing receptor antagonist, in postmenopausal women with osteoporosis after long-term use of oral bisphosphonates. Osteoporosis International. 27(1), pp. 377 - 386. https://doi.org/10.1007/s00198-015-3392-7
Vertebral fractures: Clinical importance and management
Kendler, D. L., Bauer, Doug C., Davison, K. S., Dian, L., Hanley, David A., Harris, S. T., McClung, Michael R., Miller, P. D., Schousboe, J. T., Yuen, C. K. and Lewiecki, E. Michael. (2016). Vertebral fractures: Clinical importance and management. American Journal of Medicine. 129(2), pp. 1 - 10. https://doi.org/10.1016/j.amjmed.2015.09.020
Proceedings of the 2015 Santa Fe Bone Symposium: Clinical applications of scientific advances in osteoporosis and metabolic bone disease
Lewiecki, E. Michael, Baron, Roland, Bilezikian, John P., Gagel, Robert E., Leonard, Mary B., Leslie, William D., McClung, Michael R. and Miller, Paul D.. (2016). Proceedings of the 2015 Santa Fe Bone Symposium: Clinical applications of scientific advances in osteoporosis and metabolic bone disease. United States of America: Elsevier Inc.. pp. 102 - 116 https://doi.org/10.1016/j.jocd.2015.11.003
Denosumab reduces cortical porosity of the proximal femoral shaft in postmenopausal women with osteoporosis
Zebaze, Roger M., Libanati, Cesar, McClung, Michael R., Zanchetta, Jose Ruben, Kendler, David L., Høiseth, Arne, Wang, Andrea, Ghasem-Zadeh, Ali and Seeman, Ego. (2016). Denosumab reduces cortical porosity of the proximal femoral shaft in postmenopausal women with osteoporosis. Journal of Bone and Mineral Research. 31(10), pp. 1827 - 1834. https://doi.org/10.1002/jbmr.2855
Emerging therapies for osteoporosis
McClung, Michael R.. (2015). Emerging therapies for osteoporosis. Endocrinology and Metabolism. 30(4), pp. 429 - 435. https://doi.org/10.3803/EnM.2015.30.4.429
Odanacatib for the treatment of postmenopausal osteoporosis: Development history and design and participant characteristics of LoFT, the Long-term odanacatib Fracture Trial
Bone, Henry G., Dempster, David W., Eisman, John A., Greenspan, S. L., McClung, Michael R., Nakamura, T., Papapoulos, S., Shih, W. J., Rybak-Feiglin, A., Santora, A. C., Verbruggen, Nadia, Leung, A. T. and Lombardi, Antonio. (2015). Odanacatib for the treatment of postmenopausal osteoporosis: Development history and design and participant characteristics of LoFT, the Long-term odanacatib Fracture Trial. Osteoporosis International. 26(2), pp. 699 - 712. https://doi.org/10.1007/s00198-014-2944-6
A 24-month study evaluating the efficacy and safety of denosumab for the treatment of men with low bone mineral density: Results from the ADAMO trial
Langdahl, Bente Lomholt, Teglbjaerg, Christence S., Ho, Pei-Ran, Chapurlat, Roland D., Czerwinski, Edward, Kendler, David L., Reginster, Jean Yves, Kivitz, Alan, Lewiecki, E. Michael, Miller, Paul D., Bolognese, Michael A., McClung, Michael R., Bone, Henry G., Ljunggren, Östen, Abrahamsen, Bo, Gruntmanis, Ugis, Yang, Yu-Ching, Wagman, Rachel B., Mirza, Faisal, ... Orwoll, Eric. (2015). A 24-month study evaluating the efficacy and safety of denosumab for the treatment of men with low bone mineral density: Results from the ADAMO trial. The Journal of Clinical Endocrinology and Metabolism. 100(4), pp. 1335 - 1342. https://doi.org/10.1210/jc.2014-4079
Serum 25-hydroxyvitamin D levels: Variability, knowledge gaps, and the concept of a desirable range
El-Hajj Fuleihan, Ghada, Bouillon, Roger, Clarke, Bart, Chakhtoura, Marlene, Cooper, Cyrus, McClung, Michael R. and Singh, Ravinder J.. (2015). Serum 25-hydroxyvitamin D levels: Variability, knowledge gaps, and the concept of a desirable range. Journal of Bone and Mineral Research. 30(7), pp. 1119 - 1133. https://doi.org/10.1002/jbmr.2536
Denosumab rapidly increases cortical bone in key locations of the femur: A 3D bone mapping study in women with osteoporosis
Poole, Kenneth E.S., Treece, Graham M., Gee, Andrew H., Brown, Jacques P., McClung, Michael R., Wang, Andrea and Libanati, Cesar. (2015). Denosumab rapidly increases cortical bone in key locations of the femur: A 3D bone mapping study in women with osteoporosis. Journal of Bone and Mineral Research. 30(1), pp. 46 - 54. https://doi.org/10.1002/jbmr.2325
Creation of an age-adjusted, dual-energy x-ray absorptiometry-derived trabecular bone score curve for the lumbar spine in non-hispanic US white women
Simonelli, Christine, Leib, Edward, Mossman, Ned, Winzenrieth, Renaud, Hans, Didier and McClung, Michael R.. (2014). Creation of an age-adjusted, dual-energy x-ray absorptiometry-derived trabecular bone score curve for the lumbar spine in non-hispanic US white women. Journal of Clinical Densitometry. 17(2), pp. 314 - 319. https://doi.org/10.1016/j.jocd.2013.09.002
Femoral and vertebral strength improvements in postmenopausal women with osteoporosis treated with denosumab
Keaveny, Tony M., McClung, Michael R., Genant, Harry K., Zanchetta, Jose Ruben, Kendler, David, Brown, Jacques P., Goemaere, Stefan, Recknor, Christopher, Brandi, Maria Luisa, Eastell, Richard, Kopperdahl, David L., Engelke, Klaus, Fuerst, Thomas, Radcliffe, Hoi-Shen and Libanati, Cesar. (2014). Femoral and vertebral strength improvements in postmenopausal women with osteoporosis treated with denosumab. Journal of Bone and Mineral Research. 29(1), pp. 158 - 165. https://doi.org/10.1002/jbmr.2024
Bone safety with risedronate: histomorphometric studies at different dose levels and exposure
Recker, Robert R., SteMarie, L.-G., Chavassieux, P., McClung, Michael R. and Lundy, M. W.. (2014). Bone safety with risedronate: histomorphometric studies at different dose levels and exposure. Osteoporosis International. 26(1), pp. 327 - 337. https://doi.org/10.1007/s00198-014-2850-y
Romosozumab in postmenopausal women with low bone mineral density
McClung, Michael R., Grauer, Andreas, Boonen, Steven and Bolognese, Michael A.. (2014). Romosozumab in postmenopausal women with low bone mineral density. New England Journal of Medicine. 370(5), pp. 412 - 420. https://doi.org/10.1056/NEJMoa1305224
Tibolone
McClung, M. R.. (2013). Tibolone. In In Genazzani, Andrea R. (Ed.). Postmenopausal osteoporosis : Hormones and other therapies pp. 233-238 Taylor & Francis. https://doi.org/10.1201/b14631-28
Bisphosphonate therapy for osteoporosis: Benefits, risks, and drug holiday
McClung, Michael R., Harris, Steven T., Miller, Paul D., Bauer, Doug C., Davison, K. Shawn, Dian, Larry, Hanley, David A., Kendler, David L., Yuen, Chui Kin and Lewiecki, E. Michael. (2013). Bisphosphonate therapy for osteoporosis: Benefits, risks, and drug holiday. American Journal of Medicine. 126(1), pp. 13 - 20. https://doi.org/10.1016/j.amjmed.2012.06.023
A novel monthly dosing regimen of risedronate for the treatment of postmenopausal Osteoporosis: 2-year data
McClung, Michael R., Benhamou, Claude-Laurent, Man, Zulema, Tlustochowicz, Witold, Zanchetta, Jose Ruben, Eusebio, Rachelle, Balske, Ana M., Matzkin, Ellen, Olszynski, Wojciech P., Recker, Robert R. and Delmas, Pierre D.. (2013). A novel monthly dosing regimen of risedronate for the treatment of postmenopausal Osteoporosis: 2-year data. Calcified Tissue International. 92(1), pp. 59 - 67. https://doi.org/10.1007/s00223-012-9668-4
Impact of denosumab on the peripheral skeleton of postmenopausal women with osteoporosis: Bone density, mass, and strength of the radius, and wrist fracture
Simon, James A., Recknor, Christopher, Moffett, Alfred H., Adachi, Jonathan D., Franek, Edward, Lewiecki, E. Michael, McClung, Michael R., Mautalen, Carlos A., Ragi-Eis, Sergio, Nicholson, Geoffrey Charles, Muschitz, Christian, Nuti, Ranuccio, Torring, Ove, Wang, Andrea and Libanati, Cesar. (2013). Impact of denosumab on the peripheral skeleton of postmenopausal women with osteoporosis: Bone density, mass, and strength of the radius, and wrist fracture. Menopause. 20(2), pp. 130 - 137. https://doi.org/10.1097/gme.0b013e318267f909
Efficacy and safety of risedronate 150-mg once a month in the treatment of postmenopausal osteoporosis: 2-year data
McClung, Michael R., Zanchetta, Jose Ruben, Racewicz, A., Roux, Christian, Benhamou, Claude-Laurent, Man, Zulema, Eusebio, Rachelle, Beary, J. F., Burgio, D.E., Matzkin, Ellen, Boonen, Steven and Delmas, P. D.. (2013). Efficacy and safety of risedronate 150-mg once a month in the treatment of postmenopausal osteoporosis: 2-year data. Osteoporosis International. 24(1), pp. 293 - 299. https://doi.org/10.1007/s00198-012-2056-0
Treatment of postmenopausal osteoporosis with delayed-release risedronate 35 mg weekly for 2 years
McClung, Michael R., Balske, Ana M., Burgio, D. E., Wenderoth, D. and Recker, Robert R.. (2013). Treatment of postmenopausal osteoporosis with delayed-release risedronate 35 mg weekly for 2 years. Osteoporosis International. 24(1), pp. 301 - 310. https://doi.org/10.1007/s00198-012-2175-7
Effects of pioglitazone on bone in postmenopausal women with impaired fasting glucose or impaired glucose tolerance: A randomized, double-Blind, placebo-controlled study
Bone, Henry G., Lindsay, Robert, McClung, Michael R., Perez, Alfonso T., Raanan, Marsha G. and Spanheimer, Robert G.. (2013). Effects of pioglitazone on bone in postmenopausal women with impaired fasting glucose or impaired glucose tolerance: A randomized, double-Blind, placebo-controlled study. The Journal of Clinical Endocrinology and Metabolism. 98(12), pp. 4691 - 4701. https://doi.org/10.1210/jc.2012-4096
Controversies in osteoporosis management: Concerns about bisphosphonates and when are "drug holidays" required?
McClung, Michael R.. (2013). Controversies in osteoporosis management: Concerns about bisphosphonates and when are "drug holidays" required? Clinical Obstetrics and Gynecology. 56(4), pp. 743 - 748. https://doi.org/10.1097/GRF.0b013e3182a98295
Denosumab densitometric changes assessed by quantitative computed tomography at the spine and hip in postmenopausal women with osteoporosis
McClung, Michael R., Zanchetta, Jose Ruben, Høiseth, Arne, Kendler, David L., Yuen, Chui Kin, Brown, Jacques P., Stonkus, Sigtas, Goemaere, Stefan, Recknor, Christopher, Woodson, Grattan C., Bolognese, Michael A., Franek, Edward, Brandi, Maria Luisa, Wang, Andrea and Libanati, Cesar. (2013). Denosumab densitometric changes assessed by quantitative computed tomography at the spine and hip in postmenopausal women with osteoporosis. Journal of Clinical Densitometry. 16(2), pp. 250 - 256. https://doi.org/10.1016/j.jocd.2012.02.014
Effect of denosumab on bone mineral density and biochemical markers of bone turnover: 8-year results of a phase 2 clinical trial
McClung, Michael R., Lewiecki, E. Michael, Geller, M. L. and Bolognese, Michael A.. (2013). Effect of denosumab on bone mineral density and biochemical markers of bone turnover: 8-year results of a phase 2 clinical trial. Osteoporosis International. 24(1), pp. 227 - 235. https://doi.org/10.1007/s00198-012-2052-4
In Memoriam: Sergio Ragi-Eis, MD
McClung, Michael. (2012). In Memoriam: Sergio Ragi-Eis, MD. Archives of Osteoporosis. 7(43862), pp. 1 - 2. https://doi.org/10.1007/s11657-012-0081-4
Effect of denosumab treatment on the risk of fractures in subgroupsof women with postmenopausal osteoporosis
McClung, Michael R., Boonen, Steven, Torring, Ove, Roux, Christian, Rizzoli, Rene, Bone, Henry G., Benhamou, Claude-Laurent, Lems, Willem F., Minisola, Salvatore, Halse, Johan, Hoeck, Hans C., Eastell, Richard, Wang, Andrea, Siddhanti, Suresh and Cummings, Steven R.. (2012). Effect of denosumab treatment on the risk of fractures in subgroupsof women with postmenopausal osteoporosis. Journal of Bone and Mineral Research. 27(1), pp. 211 - 218. https://doi.org/10.1002/jbmr.536
In memoriam: Sergio Ragi-Eis, MD
McClung, Michael R.. (2012). In memoriam: Sergio Ragi-Eis, MD. Journal of Clinical Densitometry. 23(6), pp. 1651 - 1652. https://doi.org/10.1007/s00198-012-1980-3
In memoriam: Sergio Ragi-Eis, MD, CCD, CDT (April 8, 1962-February 22, 2012)
Bilezikian, John P., Zerbini, Cristiano, Lewiecki, E. Michael, Borges, Joao Lindolfo, Miller, Paul D., Hans, Didier, Camargos, Bruno Muzzi and McClung, Michael R.. (2012). In memoriam: Sergio Ragi-Eis, MD, CCD, CDT (April 8, 1962-February 22, 2012). Osteoporosis International. 15(3), pp. 257 - 259. https://doi.org/10.1016/j.jocd.2012.05.003
Revisiting the prevention of bone loss at menopause
McClung, Michael R.. (2012). Revisiting the prevention of bone loss at menopause. Menopause. 19(11), pp. 1173 - 1175. https://doi.org/10.1097/gme.0b013e318274fb1d
Femoral strength in osteoporotic women treated with teriparatide or alendronate
Keaveny, Tony M., McClung, Michael R., Wan, Xiaohai, Kopperdahl, David L., Mitlak, Bruce H. and Krohn, Kelly. (2012). Femoral strength in osteoporotic women treated with teriparatide or alendronate. Bone. 50(1), pp. 165 - 170. https://doi.org/10.1016/j.bone.2011.10.002
Odanacatib in the treatment of postmenopausal women with low bone mineral density: Three-year continued therapy and resolution of effect
Eisman, John A., Bone, Henry G., Hosking, David J., McClung, Michael R., Reid, Ian R., Rizzoli, Rene, Resch, Heinrich, Verbruggen, Nadia, Hustad, Carolyn M., DaSilva, Carolyn, Petrovic, Romana, Santora, Arthur C., Ince, B. Avery and Lombardi, Antonio. (2011). Odanacatib in the treatment of postmenopausal women with low bone mineral density: Three-year continued therapy and resolution of effect. Journal of Bone and Mineral Research. 26(2), pp. 242 - 251. https://doi.org/10.1002/jbmr.212
Effects of denosumab on fracture and bone mineral density by level of kidney function
Jamal, Sophie A., Ljunggren, Östen, Stehman-Breen, Catherine, Cummings, Steven R., McClung, Michael R., Goemaere, Stefan, Ebeling, Peter R., Franek, Edward, Yang, Yu-ching, Egbuna, Ogo I., Boonen, Steven and Miller, Paul D.. (2011). Effects of denosumab on fracture and bone mineral density by level of kidney function. Journal of Bone and Mineral Research. 26(8), pp. 1829 - 1835. https://doi.org/10.1002/jbmr.403
Effects of denosumab on bone turnover markers in postmenopausal osteoporosis
Eastell, Richard, Christiansen, Claus, Grauer, Andreas, Kutilek, Stepan, Libanati, Cesar, McClung, Michael R., Reid, Ian R., Resch, Heinrich, Siris, Ethel, Uebelhart, Daniel, Wang, Andrea, Weryha, Georges and Cummings, Steven R.. (2011). Effects of denosumab on bone turnover markers in postmenopausal osteoporosis. Journal of Bone and Mineral Research. 26(3), pp. 530 - 537. https://doi.org/10.1002/jbmr.251
Osteoporosis update from the 2010 Santa Fe Bone Symposium
Lewiecki, E. Michael, Bilezikian, John P., Khosla, Sundeep, Marcus, Robert, McClung, Michael R., Miller, Paul D., Watts, Nelson B. and Maricic, Michael. (2011). Osteoporosis update from the 2010 Santa Fe Bone Symposium. Journal of Clinical Densitometry. 14(1), pp. 1 - 21. https://doi.org/10.1016/j.jocd.2010.12.001
Treatment with denosumab reduces the incidence of new vertebral and hip fractures in postmenopausal women at high risk
Boonen, Steven, Adachi, Jonathan D., Man, Zulema, Cummings, Steven R., Lippuner, K., Torring, Ove, Gallagher, J.C., Farrerons, J., Wang, Andrea, Franchimont, N., San Martin, Javier, Grauer, Andreas and McClung, Michael R.. (2011). Treatment with denosumab reduces the incidence of new vertebral and hip fractures in postmenopausal women at high risk. The Journal of Clinical Endocrinology and Metabolism. 96(6), pp. 1727 - 1736. https://doi.org/10.1210/jc.2010-2784
Markers of bone turnover for the prediction of fracture risk and monitoring of osteoporosis treatment: A need for international reference standards
Vasikaran, Samuel, Eastell, Richard, Bruyere, O., Foldes, A. J., Garnero, P., Griesmacher, Andrea, McClung, Michael R., Morris, Howard A., Silverman, S., Trenti, Tommaso, Wahl, D. A., Cooper, Cyrus and Kanis, John A.. (2011). Markers of bone turnover for the prediction of fracture risk and monitoring of osteoporosis treatment: A need for international reference standards. Osteoporosis International. 22(2), pp. 391 - 420. https://doi.org/10.1007/s00198-010-1501-1
Arzoxifene for prevention of fractures and invasive breast cancer in postmenopausal women
Cummings, Steven R., McClung, Michael R., Reginster, Jean-Yves, Cox, David, Mitlak, Bruce, Stock, John, Amewou-Atisso, Messan, Powles, Trevor, Miller, Paul, Zanchetta, Jose Ruben and Christiansen, Claus. (2011). Arzoxifene for prevention of fractures and invasive breast cancer in postmenopausal women. Journal of Bone and Mineral Research. 26(2), pp. 397 - 404. https://doi.org/10.1002/jbmr.191