The effects of discontinuing long term alendronate therapy in a clinical practice setting

Abstract

Objective: To assess bone turnover markers (BTM) and bone mineral density (BMD) after discontinuation of alendronate treatment used for five or more years. Subjects and methods: 40 patients (pt) with post-menopausal osteoporosis treated with alendronate (10 mg/d) for at least five years (Group 1, G1) had their medication discontinued. Group 2 (G2): 25 pt treated with alendronate for at least one year. Group 3 (G3): 23 treatment-naïve osteoporotic pt. BMD was evaluated in G1 and G2 at baseline and after 12 months. Collagen type I cross-linked C-telopeptide (CTX) and procollagen type 1 N-terminal propeptide (P1NP) levels were measured in all pt at baseline, and in G1 and G2 every three months for 12 months. Data were analyzed using ANOVA on ranks and Mann-Whitney tests. Results: Mean BMD values in G1 and G2 did not differ during follow-up. However, 16 pt (45.7%) in G1 and one (5.2%) in G2 lost BMD (P < 0.001). BTM at baseline was not different between G1 and G2, and both were lower than G3. A significant increase in BTM levels was detected in G1 pt after three months, but not in G2. Conclusion: Observed BMD loss and BTM rise after alendronate withdrawal imply that bone turnover was not over suppressed, and alendronate discontinuation may not be safe. Arq Bras Endocrinol Metab. 2011;55(4):272-8 Keywords Bone mineral density; bone turnover markers; alendronate discontinuation; osteoporosis RESUMO Objetivo: Avaliar a evolução dos marcadores de metabolismo ósseo (MMO) e da densidade mineral óssea (DMO) após cinco anos de uso de alendronato em mulheres osteoporóticas na pós--menopausa. Sujeitos e métodos: 40 pacientes (pct) osteoporóticas, na pós-menopausa, em uso de alendronato (10 mg/dia) por pelo menos 5 anos (Grupo 1 − G1) tiveram o uso do bisfosfonato suspenso. O grupo 2 (G2): 25 mulheres na pós-menopausa, em uso de alendronato (10 mg/dia) há pelo menos 1 ano. Grupo 3 (G3): 23 pct osteoporóticas, controles ainda sem tratamento. G1 e G2 submeteram-se à avaliação da DMO por DXA (basal e após 12 meses de seguimento). Todas as pct colheram amostras basais de CTX e P1NP, e G1 e G2 submeteram-se a coletas trimestrais de CTX e P1NP durante 1 ano. Resultados foram analisados por ANOVA on ranks e Mann-Whitney. Resultados: Níveis médios de DMO não variaram em G1 ou G2 durante o estudo; no entanto, 16 pct (45,7%) no G1 e 1 pct (5,2%) no G2 apresentaram redução clinicamente significativa de DMO (P < 0,001). Níveis basais de CTX e P1NP não diferiram entre G1 e G2, com ambos inferiores aos níveis de G3. Em G1, observou-se elevação significativa de CTX e P1NP após 3 meses. Os níveis de CTX e P1NP em G2 permaneceram estáveis durante todo o seguimento. Conclusão: Não parece haver supressão excessiva do metabolismo ósseo na prática clínica. A suspensão temporária do alendronato após seu uso prolongado pode não ser segura. Arq Bras Endocrinol Metab. 2011;55(4):272-8 Descritores Marcadores de metabolismo ósseo; densidade mineral óssea; alendronato; osteoporose

The feasibility and effect of deprescribing in older adults on mortality and health: a systematic review and meta‐analysis

“…The initial search identified 27 086 records, and 1378 were identified through other methods (Figure ). A total of 497 full papers were retrieved for further examination, and 132 papers reported 116 studies that met the inclusion criteria (Figure ) . Additional information was sought from the authors of 18 studies .…”

“…Included studies were RCTs (participants = 17 428; studies = 56) , comparative studies with a concurrent control group (participants = 14 522; studies = 22) , and comparative studies without a concurrent control group (participants = 2207; studies = 37) . Follow‐up was for a weighted mean (SD) of 15.5 ± 17.4 months.…”

“…Fourteen studies were set in hospital , 29 in residential aged care facilities , and 73 were community based, which included outpatient facilities, general practice and retirement villages . One study included participants based in the community and residential aged care , and another was based in community and hospital .…”

“…These included deprescribing (i) a single medication (e.g. atenolol) ; (ii) a single pharmacological class (e.g. beta‐blockers) ; or (iii) a single therapeutic category (e.g.…”

Evaluation of bone turnover after bisphosphonate withdrawal and its influence on implant osseointegration: an in vivo study in rats

“…These findings are consistent with our previous studies [18][19][20]22] in normal or in ovariectomized rats, in which the increase in BMD in femurs and vertebrae after treatment with alendronate could be observed. Some clinical and pre-clinical studies [35][36][37][38] point to decreased BMD after antiresorptive discontinuation. Our findings did not reveal any change in the BMD values in both femurs and vertebrae even after 73 days of alendronate withdrawal.…”