Poster Presentation ESA-SRB-ANZBMS 2024 in conjunction with ENSA

Romosozumab as treatment for severe osteoporosis in heart and lung transplant recipients (#380)

Lisa M Raven 1 2 3 , Jacqueline R Center 1 2 3 , Christopher A Muir 1 3
  1. Department of Endocrinology, St Vincent's Hospital, Darlinghurst, NSW, Australia
  2. Garvan Institute of Medical Research, Darlinghurst, New South Wales, Australia
  3. School of Clinical Medicine, St Vincent’s Campus, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia

Osteoporosis is common in transplant recipients and fracture risk is high. Standard treatment is with anti-resorptive medications. Despite high fracture rates, there are limited data on the use of anabolic bone therapies in transplant recipients.

 

Aim: To evaluate skeletal outcomes after treatment with romosozumab for 12-months in heart and lung transplant recipients.

 

Methods: Retrospective analysis of transplant recipients who completed 12 months of romosozumab at a single centre.

 

Results: Six transplant recipients completed 12-months of romosozumab, commenced after a median 3 years post-transplant (range 2-20). Four patients (66%) were still receiving prednisolone treatment at the time of starting romosozumab. All patients had a history of fracture, with the majority (5/6) having at least 1 vertebral fracture. All had previously received anti-resorptive therapy (4 with zoledronate, 2 with denosumab for > 2 years). Following completion of romosozumab, all patients were consolidated with zoledronate or denosumab. Bone mineral density (BMD) was measured prior and after completion of romosozumab. Median baseline lumbar spine (LS) T-score measured -2.3 SD (range -3.1 to +0.9) and total femur T-score measured -2.2 SD (range -2.9 to -1.6). Most (5/6) patients experienced an increase in BMD at the LS (median change +7.1%; range -16.5 to 25.0). One patient did not experience improvement in LS BMD, they had received 3 doses of zoledronate and 4 years of denosumab prior to romosozumab. Most (5/6) patients did not experience clinically significant change in total femur BMD, apart from one patient who experienced 9% gain. Three patients (50%) experienced subsequent fractures during (1/3) or after completing (2/3) romosozumab treatment. 

 

Conclusion: Severe osteoporosis is highly prevalent in transplant recipients. Most patients in our study had improvement in LS BMD following romosozumab treatment, yet new fractures still occurred. The appropriate use of romosuzumab in heart and lung transplant patients with osteoporosis requires further study.