In 51 migraine patients treated with anti-CGRP antibodies, treatment duration was not associated with bone mineral density abnormalities — menopause and anti-seizure drug use were the significant risk factors.
No association foundAnti-CGRP treatment duration was not linked to bone density abnormalities in 51 migraine patients over a mean of 15.7 months, though menopause (OR 11.6) and anti-seizure drugs (OR 12.8) were significant predictors
What the researchers found
Among 51 migraine patients (43 female, mean age 46 years) treated with anti-CGRP monoclonal antibodies for an average of 15.7 months, 53% had bone density abnormalities (22 with osteopenia, 5 with osteoporosis). However, logistic regression analysis found no association between anti-CGRP treatment duration and bone density abnormalities.
The significant predictors of reduced bone density were menopause (OR 11.641, 95% CI 1.486–91.197, p=0.019) and anti-seizure drug use (OR 12.825, 95% CI 1.162–141.569, p=0.037) — both well-established risk factors for osteoporosis independent of CGRP therapy.
Why it matters
Anti-CGRP monoclonal antibodies (erenumab, fremanezumab, galcanezumab) are among the most important advances in migraine treatment in decades, but since CGRP promotes bone formation, there's been legitimate concern that blocking it long-term could cause bone loss. This is the first study specifically examining this safety question, and the initial findings are reassuring — though the small size means the question remains open.
How the study worked
This was a single-center, cross-sectional cohort study of migraine patients who underwent bone densitometry (DEXA scan) during anti-CGRP antibody treatment. Patients were classified as OSTEO+ (T-score ≤ -1) or normal. The association between OSTEO+ status, anti-CGRP treatment duration, and established osteoporosis risk factors was analyzed using logistic regression models.
What this study cannot tell us
The study had a small sample size (51 patients) with wide confidence intervals on the odds ratios, limiting statistical power. The cross-sectional design cannot establish causation or detect gradual changes over time. There was no baseline bone density measurement before starting anti-CGRP treatment. The mean treatment duration of 15.7 months may be too short to detect bone effects. The single-center design limits generalizability.
How to read the evidence
This is a small, single-center, cross-sectional cohort study without baseline measurements. While it provides initial reassurance, the wide confidence intervals and lack of longitudinal design limit the strength of conclusions. The authors themselves describe the findings as preliminary.
When this study was published
Published in 2024, this is a timely study addressing a safety concern that has grown with the widespread adoption of anti-CGRP monoclonal antibodies for migraine since their FDA approval in 2018.
The bigger picture
This study sits at an important intersection of migraine therapeutics and bone health. CGRP's role in bone metabolism has been well-established in preclinical research, making this safety monitoring clinically essential as millions of patients now take anti-CGRP drugs. The lack of association with treatment duration is reassuring but preliminary — as these drugs are used for years or decades, ongoing bone density surveillance will be important.
Questions still open
- Would longer anti-CGRP treatment durations (5+ years) reveal bone density effects not detectable in this 16-month study?
- Should bone density monitoring be recommended for migraine patients on anti-CGRP therapy who have additional osteoporosis risk factors?
- Do different anti-CGRP antibodies (targeting the peptide vs. the receptor) have different effects on bone metabolism?
Common questions
Why would anti-CGRP migraine drugs affect bones?
Should migraine patients on anti-CGRP drugs get bone density scans?
Read the original research
Assessment of Bone Mineral Density Over 1 Year in a Cross-Sectional Cohort of Migraine Patients Receiving Anti-CGRP Monoclonal Antibodies.
CNS drugs, 38(10), 819-825
Citation
Para, Davide; Camponovo, Chiara; Riccitelli, Gianna Carla; Mallucci, Giulia; Maino, Paolo; Mondini Trissino da Lodi, Camilla; Saudina, Demurtas; Trimboli, Pierpaolo; Gobbi, Claudio; Zecca, Chiara. (2024). Assessment of Bone Mineral Density Over 1 Year in a Cross-Sectional Cohort of Migraine Patients Receiving Anti-CGRP Monoclonal Antibodies.. CNS drugs, 38(10), 819-825. https://doi.org/10.1007/s40263-024-01104-0