Risk factors for vertebral fractures and bone loss after denosumab discontinuation: A real-world observational study.

Everts-Graber, J; Reichenbach, Stephan; Gahl, Brigitta; Ziswiler, H R; Studer, U; Lehmann, T (2021). Risk factors for vertebral fractures and bone loss after denosumab discontinuation: A real-world observational study. Bone, 144, p. 115830. Elsevier 10.1016/j.bone.2020.115830

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BACKGROUND

Denosumab discontinuation without subsequent bisphosphonates (BPs) is associated with bone loss and multiple vertebral fractures.

OBJECTIVE

Identifying risk factors for bone loss and vertebral fractures after denosumab discontinuation.

METHODS

This retrospective study measured the outcome of 219 women with osteoporosis who discontinued denosumab treatment and received subsequent treatment with zoledronate, other BPs or a selective estrogen receptor modulator (SERM), or no therapy. Fracture rate, longitudinal bone mineral density (BMD) changes and bone turnover markers (BTMs) within 2 years after denosumab discontinuation were analysed. Linear regression analysis evaluated loss of BMD and age, BMI (kg/m2), denosumab treatment duration, pre-treatment, prior fracture state, baseline T-scores, use of glucocorticoids or aromatase inhibitors and BMD gains under denosumab therapy.

RESULTS

171 women received zoledronate after denosumab discontinuation, 26 had no subsequent treatment and 22 received other therapies (other BPs or a SERM). Zoledronate was associated with the fewest vertebral fractures (hazard ratio 0.16, p = 0.02) and all subsequent therapies retained BMD at all sites to some extent. Higher BMD loss was associated with younger age, lower BMI, longer denosumab treatment, lack of prior antiresorptive treatment and BMD gain under denosumab treatment. BTM levels correlated with denosumab treatment duration and bone loss at the total hip, but not the lumbar spine.

CONCLUSIONS

Compared to no subsequent therapy, zoledronate was associated with fewer vertebral fractures after denosumab. Further, BMD loss depended on denosumab treatment duration, age, prior BP therapy and BMD gain under denosumab therapy, whereas BTM levels were associated with bone loss at the total hip and denosumab treatment duration.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Pre-clinic Human Medicine > CTU Bern
04 Faculty of Medicine > Department of Dermatology, Urology, Rheumatology, Nephrology, Osteoporosis (DURN) > Clinic of Rheumatology, Clinical Immunology and Allergology
04 Faculty of Medicine > Pre-clinic Human Medicine > Institute of Social and Preventive Medicine (ISPM)

UniBE Contributor:

Reichenbach, Stephan and Gahl, Brigitta

Subjects:

300 Social sciences, sociology & anthropology > 360 Social problems & social services
600 Technology > 610 Medicine & health

ISSN:

8756-3282

Publisher:

Elsevier

Language:

English

Submitter:

Doris Kopp Heim

Date Deposited:

05 Jan 2021 10:36

Last Modified:

05 Jan 2021 16:20

Publisher DOI:

10.1016/j.bone.2020.115830

PubMed ID:

33359006

Uncontrolled Keywords:

Bisphosphonates Denosumab Discontinuation Fracture Osteoporosis

BORIS DOI:

10.48350/150676

URI:

https://boris.unibe.ch/id/eprint/150676

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