Summary
A retrospective study of 121 patients who stopped denosumab (Dmab) then received no treatment (NT), risedronate (RIS), alendronate (ALN), or zoledronic acid (ZOL). Bone density (spine and hip) during and after Dmab discontinuation was measured. Treatment with ALN or ZOL, not NT and RIS, mitigated BMD loss after Dmab discontinuation.
Introduction
Denosumab (Dmab) discontinuation is associated with bone loss and multiple vertebral fractures. The purpose was to compare bone mineral density (BMD) change in patients following Dmab discontinuation with no subsequent treatment (NT) and three bisphosphonate (BP) treatments: risedronate (RIS), alendronate (ALN), and zoledronic acid (ZOL).
Methods
In a review of 121 patients aged 71.2 ± 8.1 years, discontinuing Dmab (mean 5.4 doses), 33 received NT and 88 received BP (22 RIS; 34 ALN; 32 ZOL). BMD change after 1 year was compared between groups at the lumbar spine (LS), femoral neck (FN), and total hip (TH). Risk factors for bone loss after Dmab discontinuation were compared between groups and incidence of vertebral fractures was determined.
Results
Following Dmab discontinuation, LS mean change (g/cm
2
; 95% CI) was for NT: − 0.041 (− 0.062 to − 0.021); RIS: − 0.035 (− 0.052 to − 0.017); ALN: − 0.005 (− 0.020 to 0.009); and ZOL: − 0.009 (− 0.025 to 0.008). Differences in LS were found between NT and ALN (
p =
0.015), and NT and ZOL (
p=
0.037), but not between NT and RIS. The only significant difference in TH was found between NT and ZOL (
p
0.034) with no group differences in FN. BMD gains during Dmab treatment were associated with BMD loss after Dmab discontinuation. In a subset, discontinuation after Dmab treatment (> 5 doses) followed by ALN (
n
= 22) and ZOL (
n
= 11) showed no difference in BMD. Five of 7 vertebral fractures occurred after Dmab discontinuation in NT.
Conclusion
Subsequent treatment with ALN or ZOL but not NT and RIS mitigates BMD loss after Dmab discontinuation.
Supplementary information
The online version contains supplementary material available at 10.1007/s00198-022-06648-9.
In this article, we establish a baseline status of clinical and basic research in the area of osteoporosis and fragility fractures, focused primarily on research published within the past 12 to 24 months. This topic will be an addition to the JBJS annual list of Guest Editorial topics.Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJS/H163).
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