“The molecular approach of denosumab treatment—inhibition of osteoclast differentiation and activity via blockade of RANK ligand—hits the core pathological mechanism of wear-induced osteolysis,” he says.
Like Dr. Wilkinson, he pointed to randomized clinical trials as the next step. “The obvious main goal is the prevention of disease progression in patients with stable well-fixed implants,” he affirms. “Potentially, denosumab could also be applied to improve the success of surgical curettage and bone grafting.”
“As an ideal target,” he adds, “denosumab could control osteolytic lesions in patients with age-related low bone mineral density and in patients with advanced rheumatoid arthritis, who poorly tolerate revision surgery due to inherent skeletal fragility.”
“As a limitation, the lesions may reappear after cessation of the medication,” he says. “The potential, albeit rare, adverse events of using denosumab in arthroplasty patients include osteonecrosis of the jaw and atypical femur fractures, even in the periprosthetic region.”
The study was funded by Amgen. The authors received a grant from Amgen to conduct the study.
References
- Mahatma MM, Jayasuriya RL, Hughes D, et al. Effect of denosumab on osteolytic lesion activity after total hip arthroplasty: a single-center, randomized, double-blind, placebo-controlled, proof of concept trial. Lancet Rheumatol. 2021 Jan 11. Online first.
- Aro HT. The potential use of denosumab in patients with arthroplasty. Lancet Rheumatol. 2021 Jan 11. Online first.