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The cortical effects of denosumab seem to be fairly unique for an antiresorptive drug, such as increased cortical thickness and continued decrease in cortical porosity, properties most important for vBMD and bone strength. These may contribute to the further decrease in nonvertebral fractures reported after 4 years of long-term Selleckchem Liraglutide denosumab treatment and in the crossover group during years 4�C7, and the decrease in wrist fractures during years 4�C5 after long-term treatment in the FREEDOM extension study [Bilezikian et al. 2014; Ferrari et al. 2013]. Strength Radius Increased bone mass in the forearm with denosumab treatment is also reflected in an increased strength of the forearm [estimated by polar moment of inertia (PMI)] which has been observed in the FREEDOM and DEFEND studies [Simon et al. 2013; Genant et al. 2010]. The positive effects on bone strength (PMI) of the radius seem greater with denosumab than with ALN treatment (p this website femoral neck and spine which was highly correlated with bone mass [Ominsky et al. 2011]. The increased strength may be explained by a decreased remodeling and cortical porosity and increased cortical thickness [Kostenuik et al. 2011; Ominsky et al. 2011]. A large number of osteoporotic hip fractures occur in the trochanter region due to falls, and denosumab treatment reduced the number of hip fractures by 40% in the FREEDOM study [Cummings et al. 2009]. Interestingly, recent data derived from three-dimensional cortical bone mapping point towards strengthening of the femoral cortex and lateral trochanter region by denosumab treatment. In a substudy of 80 denosumab-treated women in the FREEDOM trial a significant increase in femoral cortical Oxymatrine density and thickness by 5.4% compared with placebo was already evident at 12 months [Poole et al. 2014]. Also, increased cortical mass surface density and cortical thickness of up to 12% occurred at the lateral femoral trochanter region in the denosumab group relative to the placebo-treated group after 36 months [Poole et al. 2014]. One third of the increase in the femoral cortical mass came from increasing cortical density, and two thirds from increasing cortical thickness relative to placebo [Poole et al. 2014].