Romosozumab for managing severe osteoporosis in patients undergoing kidney transplantation: A retrospective case series

Abstract Recipients of kidney grafts often develop severe osteoporosis. However, no consensus has emerged on the most appropriate medications for managing osteoporosis in these recipients. In this study, we investigated the efficacy of romosozumab as an additional treatment option for managing severe osteoporosis in kidney transplant recipients. Our retrospective observational study included 12 such recipients who were treated with romosozumab for 12 months—8 newly initiated on romosozumab and 4 treated with romosozumab after initial treatment with other agents. Endpoints were side effects, new fractures, blood tests, and changes in bone mineral density. Pearson correlation coefficients were used to assess associations of the percent change in bone mineral density after 1 year of treatment with age, dialysis duration, and time (years) since transplantation. During treatment with romosozumab, the patients did not develop severe hypocalcemia or experience marked deterioration of kidney function at 1 year post-treatment. Metabolic markers of bone formation and resorption were similar to those in the general population with osteoporosis. The average changes in bone mineral density at the spine and total hip were 15.18% and 8.83%, respectively, indicating a favorable increase. Further, the change in spine bone mineral density was inversely correlated with age and time since transplantation. Treatment of osteoporosis with romosozumab was observed to be safe for kidney transplant recipients and had a favorable therapeutic effect on both spine and hip bone mineral density.