Background/Purpose: The use of immune checkpoint inhibitors (ICIs) is becoming increasingly important in the management of melanoma. However, although ICIs are associated with various immune-related adverse events (irAEs), their potential effect on the skeleton—particularly on bone mineral density (BMD) and the occurrence of fractures—has been little described. The aim of this study is to assess the changes in BMD on CT scans in patients with melanoma treated with ICIs at one and two years and to investigate the factors associated with these changes.

Methods: We conducted a real-world, retrospective cohort study. Patients were recruited from outpatient dermatology clinic between October 2014 and 1 December 2023. Inclusion criteria for patients were: male or female, age ≥ 18 years, histologically confirmed melanoma, first treatment with immunotherapy (according to current treatment guidelines and after discussion in a multidisciplinary tumor board), with CT imaging follow-up both before and after initiation of immunotherapy, and follow-up of at least one year after initiation of immunotherapy. Patients were excluded if they met any of the following criteria: history of bone fragility disorders or osteoporotic fractures, spinal surgery, vertebral metastases. BMD was measured at baseline (T0), 1 year (T1) and 2 years (T2) at the L1 vertebrae. Changes in CT-based BMD over time were analyzed using paired Student’s t-tests, and risk factors for BMD changes were analyzed using linear regression models.

Results: 165 patients (mean age: 65 years; 44.2% women) were included. BMD decreased significantly over 2 years (mean difference: 14.02 HU, 95% CI 10.31-17.74, p < 0.001), with bone loss rates of 5.15% and 11.91% at 1 and 2 years, respectively. Male gender (β 8.87; [95%CI 3.62 to 14.11]; p=0.001) and younger age (β -0.34; [95%CI -0.5 to -0.09]; p=0.005) were associated with greater BMD loss at 1 year.Compared with patients in complete remission, those with disease progression (β 8.25 [95% CI 2.27 to 19.75]; p=0.002) or partial response (β 8.25 [95% CI 2.98 to 13.53]; p=0.002) experienced a greater decrease in BMD at 2 years.

Conclusion: ICIs are associated with significant BMD loss, particularly in men. These findings underscore the importance of osteoporosis prevention and routine BMD monitoring during ICI therapy

« Back to ACR Convergence 2025

ACR Meeting Abstracts - https://acrabstracts.org/abstract/changes-in-scanographic-bone-mineral-density-in-melanoma-patients-treated-with-immunotherapy/