# RANK-ligand inhibition to combat sarcopenia with underlying osteoporosis: a study protocol for a randomized, double-blind, double-dummy, active-controlled trial

## TL;DR

This study tests if denosumab, a drug that inhibits RANKL, can treat sarcopenia in older adults with osteoporosis.

## Contribution

The study introduces a clinical trial protocol to evaluate denosumab's efficacy in treating osteosarcopenia.

## Key findings

- Denosumab may reduce muscle atrophy by inhibiting RANKL in patients with osteosarcopenia.
- The trial will compare denosumab to zoledronic acid for muscle strength and mass outcomes.
- Results could provide a new treatment for sarcopenia with underlying osteoporosis.

## Abstract

Sarcopenia is an age-related disease characterized by gradual loss of muscle strength and muscle mass. Osteosarcopenia is the presence of osteopenia/osteoporosis and sarcopenia, which poses an increased risk of falls and fractures. Currently, there is no Food and Drug Administration (FDA) approved drug for treating sarcopenia. Previous studies showed that nuclear factor-κB ligand (RANKL) inhibition could reduce muscle atrophy and could be a therapeutic target for treating sarcopenia. Denosumab is an anti-osteoporotic drug with RANKL inhibition. This study aims to investigate the effects of denosumab to treat sarcopenia in patients with underlying osteoporosis.

This study is a randomized, double-blind, double-dummy, active-controlled trial for investigating the efficacy of denosumab in treating sarcopenia in patients with osteosarcopenia. Participants aged 65 years or above with osteosarcopenia will be recruited. Participants will be randomized into the denosumab group or the zoledronic acid group and will be followed up for 1 year. The primary outcomes are muscle strength, muscle mass measured by dual-energy x-ray absorptiometry (DXA) scan, and physical performance. The secondary outcomes are the clinical outcomes, including fall rate, fracture rate and mortality.

This study will study the potential therapeutical effects of denosumab (RANKL inhibitor) on osteosarcopenia, which will be crucial given the aging population and expected increase in disease numbers.

ClinicalTrials.gov, NCT06643780. Registered on 16 October 2024. (Retrospectively registered and no protocol changes were made since the recruitment was started for this study).

The online version contains supplementary material available at 10.1186/s13063-025-08976-7.