An Essential Warning

Leder, Benjamin Z.

doi:10.1002/jbmr.3359

Cited by 18 publications

(16 citation statements)

References 18 publications

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“…Moreover, since bisphosphonates are deposited on areas of bone resorption, they must probably be administered when the rebound effect associated with the denosumab discontinuation has already begun as measured by the increase in bone turnover markers. This consideration is of little importance if an oral bisphosphonate is administered repeatedly but may be essential if one course of zoledronate is administered [ 10 , 18 ]. Delaying administration of intravenous bisphosphonate when transitioning from denosumab was demonstrated to maintain the gains in BMD [ 19 ].…”

Section: Discussionmentioning

confidence: 99%

Raloxifene Has No Efficacy in Reducing the High Bone Turnover and the Risk of Spontaneous Vertebral Fractures after Denosumab Discontinuation

Gonzalez‐Rodriguez

Stoll

Lamy

2018

Case Reports in Rheumatology

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At denosumab discontinuation, an antiresorptive agent is prescribed to reduce the high bone turnover, the rapid bone loss, and the risk of spontaneous vertebral fractures. We report the case of a woman treated with aromatase inhibitors and denosumab for 5 years. Raloxifene was then prescribed to prevent the rebound effect. Raloxifene was ineffective to reduce the high bone turnover and to avoid spontaneous clinical vertebral fractures. We believe that among the antiresorptive treatments, the most powerful bisphosphonates should be favored, and their administration adapted according to the serial follow-up of bone markers.

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Section: Discussionmentioning

confidence: 99%

Raloxifene Has No Efficacy in Reducing the High Bone Turnover and the Risk of Spontaneous Vertebral Fractures after Denosumab Discontinuation

Gonzalez‐Rodriguez

Stoll

Lamy

2018

Case Reports in Rheumatology

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“…Die Wirksamkeit von Alendronat oder Zoledronat in der Situation eines Rebounds ist bislang nur explorativ nach kurzfristiger Anwendung von Denosumab beschrieben worden. Eine rein anabole wirksame Anschlussbehandlung mit Teriparatid nach Denosumab sollte vermieden werden [37], diese Abfolge der Therapie wird zwischenzeitlich sogar als kontraindiziert bezeichnet [38]. Dies kann jedoch im klinischen Alltag prekär sein, wenn unter Denosumab oder eben nach Unterbrechen des 6-monatlichen Anwendungszyklus neue Wirbelkörperfrakturen aufgetreten sind, Teriparatid daraufhin begonnen, aber Denosumab dann nicht mehr parallel weitergeführt wird.…”

Section: Implikationen Für Die Praxisunclassified

Denosumab – die reversible Wirksamkeit im klinischen Fokus

Popp

2019

Osteologie

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ZusammenfassungSeit der Registrierung von Denosumab 60 mg 6-monatlich subkutan zur Therapie der postmenopausalen Osteoporose konnte eine anhaltende Wirksamkeit über 10 Jahre gezeigt werden. Abgesehen von den eher seltenen unerwünschten Ereignissen, wie dem Auftreten von Osteonekrosen des Kiefers oder atypischen Femurschaftfrakturen, sind keine neuen Aspekte bei der Langzeitanwendung von Denosumab berichtet. Die Reversibilität nach dem Therapieabbruch von Denosumab führt zu einem rasch einsetzenden Knochenmineralverlust und kann in bestimmten Fällen mit dem erhöhten Risiko für multiple Wirbelkörperfrakturen assoziiert sein. Solange keine kontrollierten Studien vorliegen, welche die Wirksamkeit einer sicheren Strategie einer Anschlussbehandlung zur Kompensation des Rebound-Phänomens belegen, muss generell vom Therapieabbruch von Denosumab abgeraten werden. Teriparatid allein nach Stopp von Denosumab wird als kontraindiziert bezeichnet. Eine sequentielle, antiresorptive Anschlussbehandlung muss dem Einzelfall angepasst werden.

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“…(49,69) Indeed, it has been suggested that the discontinuation of denosumab should be uniformly followed by a bisphosphonate (despite only limited evidence of the utility of this approach at present). (70)(71)(72) Unfortunately, there are currently no trials addressing the optimal timing of bisphosphonate therapy initiation after denosumab or which bisphosphonate to choose. Given bisphosphonates' mechanism of action and preferential deposition at sites of active bone remodeling, (73) however, it is plausible that if the bisphosphonate is administered while denosumab's antiresorptive effects are still maximal, the drug may be less effective than if given to a patient in whom the effects of denosumab are no longer evident and robust bone turnover is ongoing.…”

Section: Anabolic Agents After Antiresorptive Agentsmentioning

confidence: 99%

“…Indeed, it has been suggested that the discontinuation of denosumab should be uniformly followed by a bisphosphonate (despite only limited evidence of the utility of this approach at present) . Unfortunately, there are currently no trials addressing the optimal timing of bisphosphonate therapy initiation after denosumab or which bisphosphonate to choose.…”

Section: Introductionmentioning

confidence: 99%

Optimizing Sequential and Combined Anabolic and Antiresorptive Osteoporosis Therapy

Leder

2018

JBMR Plus

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As osteoporosis therapy options have expanded, and clinical guidelines have begun to embrace the concept of limited treatment courses and “drug holidays,” the choices that physicians must make when initiating, electing to continue, or switching therapies have become more complex. As a result, one of the fundamental issues that must be carefully considered is whether, when, and in what sequence anabolic therapies should be utilized. This review evaluates the current evidence supporting the optimal sequence for the use of anabolic and antiresorptive drugs and assesses the expanding number of clinical trials favoring the initial use of anabolic therapy followed by an antiresorptive agent. This review also explores the evidence suggesting that the effectiveness of anabolic medications are diminished when used in patients that have been previously treated with specific antiresorptive drugs for prolonged periods. Finally, the recent advances in designing combination antiresorptive/anabolic treatment approaches are detailed, with a focus on combined denosumab/teriparatide regimens, which appear to provide the most substantial and clinically relevant skeletal benefits to patients with established osteoporosis. © 2018 The Authors. JBMR Plus is published by Wiley Periodicals, Inc. on behalf of the American Society for Bone and Mineral Research.

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An Essential Warning

Cited by 18 publications

References 18 publications

Raloxifene Has No Efficacy in Reducing the High Bone Turnover and the Risk of Spontaneous Vertebral Fractures after Denosumab Discontinuation

Raloxifene Has No Efficacy in Reducing the High Bone Turnover and the Risk of Spontaneous Vertebral Fractures after Denosumab Discontinuation

Denosumab – die reversible Wirksamkeit im klinischen Fokus

Optimizing Sequential and Combined Anabolic and Antiresorptive Osteoporosis Therapy

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