Pérdida de stock óseo no osteoporótico en la columna. Denosumab como herramienta de tratamiento e implicancia

• Pedro Luis Bazán ^[1] ; Alfredo Godoy Adaro ^[2] ; Gilmar Leonardo Hernández Molina ^[3] ; Richard Ángel Blanco Payano ^[4] ; Micalea Cinalli ^[1]
  1. [1] Unidad de Patología Espinal, Servicio de Ortopedia y Traumatología, Hospital Interzonal General de Agudos “General San Martín”, La Plata, Buenos Aires, Argentina
  2. [2] Sección Columna, Clínica Modelo S.A. Paraná, Entre Ríos, Argentina
  3. [3] Unidad de Columna, Hospital Militar, Bogotá, Colombia
  4. [4] Servicio de Ortopedia y Traumatología, Hospital Regional de Loreto “Felipe Santiago Arriola Iglesias”, Iquitos, Perú

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• Localización: Revista de la Asociación Argentina de Ortopedia y Traumatología, ISSN 1852-7434, Vol. 89, Nº. 1, 2024 (Ejemplar dedicado a: Sociedad Argentina de Patología de la Columna Vertebral), págs. 83-89
• Idioma: español
• DOI: 10.15417/issn.1852-7434.2024.89.1.1802
• Títulos paralelos:
  • Non-osteoporotic Loss of spinal Bone. Denosumab as a Therapeutic Tool and its Implications
• Enlaces
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• Resumen
  • español

    Introducción: El denosumab es un anticuerpo monoclonal humano que actúa contra el RANKL, inhibiendo la destrucción ósea mediada por los osteoclastos, así evitando la pérdida de stock óseo; por este motivo, se lo utiliza en el tratamiento de la osteoporosis como agente antiresortivo y está autorizado para el tratamiento del tumor de células gigantes y el mieloma múltiple. Nuestro objetivo fue conocer las indicaciones y contraindicaciones para la pérdida de stock óseo de causa no osteoporótica.

    Materiales y Métodos: Revisión sistemática de artículos en inglés publicados en el período 2009-2023. Se incluyeron artículos que indicaran o contraindicaran el uso del denosumab.

    Resultados: De un total inicial de 4306 artículos, se analizaron 18 artículos que mostraban consenso en la dosis y los controles con tomografía e indicaban o contraindicaban el uso del denosumab.

    Conclusiones: El denosumab está indicado como una buena opción de tratamiento preferente de tumores vertebrales primarios inoperables, para evitar recidivas o demorar las metástasis de tumores primarios o de tumores sólidos, principalmente de mama, próstata y pulmón, y para el compromiso vertebral del mieloma múltiple. El denosumab está contraindicado, por el momento, para las lesiones infecciosas.

  • English

    Background: Denosumab is a human monoclonal antibody that acts against RANKL, inhibiting bone destruction mediated by os-teoclasts, thus avoiding bone loss. For this reason, it is used in the treatment of osteoporosis as an antiresorptive and is authorized for the treatment of giant cell tumor and multiple myeloma. Our objective is to understand its indications and contraindications for the treatment of non-osteoporotic bone loss. materials and methods: A systematic review of English-language articles published between 2009 and 2023, using PRISMA criteria. Articles indicating or contraindicating the use of denosumab were considered for inclusion. Results: From a total of 4306 articles, 18 articles were analyzed, which showed consensus on the dose and controls with tomography and indicated or contraindicated the use of denosumab. Conclusions: Denosumab is recommended as a prima-ry therapeutic option for unresectable spinal tumors, to prevent recurrences or to delay the formation of metastases from primary tumors or solid tumors, primarily breast, prostate, and lung, as well as for multiple myeloma spinal involvement. Denosumab is currently contraindicated in infectious lesions.

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