Bone loss after denosumab discontinuation is prevented by alendronate and zoledronic acid but not risedronate: a retrospective study

Tutaworn, Teerapat; Nieves, Jeri W.; Wang, Zhaorui; Levin, Justin E; Yoo, Jae E; Lane, Joseph M.

doi:10.1007/s00198-022-06648-9

Cited by 25 publications

(14 citation statements)

References 49 publications

(70 reference statements)

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“…To determine a viable strategy to counter the rebound process, Tutaworn et al 13 performed a retrospective study of 121 patients who stopped denosumab and then received no treatment (33 patients), risedronate (22 patients), alendronate (34 patients), or zoledronic acid (32 patients). Differences in lumbar spine bone density were found between the no-treatment and alendronate groups (p = 0.015) and between the no-treatment and zoledronic acid groups (p = 0.037), but not between the no-treatment and risedronate groups.…”

Section: Osteoporosis Drug Therapymentioning

confidence: 99%

What’s New in Osteoporosis and Fragility Fractures

Lane

Witayakom

2023

Journal of Bone and Joint Surgery

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Update This article was updated on April 10, 2024, because of a previous error. On page 1304, the term “protein” that appeared incorrectly three times in the text that had read as “Their studies did reveal that metabolites from the protein pump inhibitor ingestion may directly and indirectly influence bone density through plasma metabolites involved in the sex hormone pathway. This article plus others have broadened the possible altered pathways related to protein pump inhibitor use. Regardless, these commonly used agents will compromise bone health. Clinicians should be alerted to this possibility when protein pump inhibitors are ingested.,” has now been replaced with the term “proton” so that the text now reads as “Their studies did reveal that metabolites from the proton pump inhibitor ingestion may directly and indirectly influence bone density through plasma metabolites involved in the sex hormone pathway. This article plus others have broadened the possible altered pathways related to proton pump inhibitor use. Regardless, these commonly used agents will compromise bone health. Clinicians should be alerted to this possibility when proton pump inhibitors are ingested.”

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Section: Osteoporosis Drug Therapymentioning

confidence: 99%

What’s New in Osteoporosis and Fragility Fractures

Lane

Witayakom

2023

Journal of Bone and Joint Surgery

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“… 21 In a recent publication, Tutaworn et al. 22 retrospectively analyzed clinical data of almost 120 patients who received a median of 5 doses of Dmab and who were separated into 4 groups (no sequential treatment, risedronate, alendronate, and zoledronate). They found no significant changes during the 12-month follow-up between the zoledronate and alendronate group (1 vertebral fracture was reported in each group).…”

Section: Discussionmentioning

confidence: 99%

“…Finally, the no-treatment group had the highest bone mass loss and 5 RVFs, 4 of which were multiple vertebral fractures. 22 …”

Section: Discussionmentioning

confidence: 99%

Three-year effect of bisphosphonates on bone mineral density after denosumab withdrawal: observations from a real-world study

Farias,

Jerkovich,

Barragán

et al. 2024

JBMR Plus

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Data on long-term treatment regimens for preventing bone mineral density (BMD) loss that occurs after denosumab (Dmab) withdrawal are scarce. Our aim was to evaluate the long-term changes (12 to 36 months) in BMD and bone turnover markers in a group of postmenopausal women who had been treated with Dmab and received subsequent treatment with bisphosphonates. Secondary objectives were to evaluate factors associated with BMD loss, to compare the BMD change in patients who received oral vs. intravenous bisphosphonates, and to assess the frequency of fragility fractures after Dmab discontinuation. The clinical data of 54 patients, 26 of whom had clinical and DXA assessments at 36 months, were analyzed. After 12 months, the mean LS BMD had decreased by 2.8% (±5.0), FN BMD by 1.9% (±5.8) and TH BMD by 1.9% (±3.7). After 36 months, LS BMD had decreased by 3.7% (±6.7), FN BMD by 2.5% (±7.1), and TH BMD by 3.6% (±5.2). C-terminal cross-linked telopeptide of type I collagen significantly increased during the first 12 months after Dmab withdrawal but then decreased at 36 months. BMD loss at 12 months was higher in patients with more than 30 months of Dmab treatment, but this difference was only statistically significant at FN (-3.3% vs -0.3%, p=0.252 at LS, -3.3% vs 0.3%, p=0.033 at FN and -2.1% vs 0.9, p=0.091 at TH). There were no statistically significant differences regarding the change in BMD at 12 and 36 months between oral and intravenous treatment. Seven patients suffered incidental vertebral fractures (clinical vertebral fractures: n= 6, morphometric fractures: n= 1) 3 of which were multiple. None of these patients were treated following international or institutional guidelines or recommendations. In summary, our study suggests that bisphosphonates can help maintain BMD for 36 months after Dmab discontinuation.

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“…BP and RAL can be discontinued without need for sequential therapy. DEN, PTH/PTHrP, and ROM should be transitioned to anti-resorptive therapy, but the best formulation and duration of treatment is unclear at this time (68)(69)(70). Discontinuation of DEN can be associated with vertebral fractures that may be averted if a BP is started 6 to 7 months after the last DEN administration (41,42).…”

Section: Recommendations For Initial Treatment Failurementioning

confidence: 99%

2022 American College of Rheumatology Guideline for the Prevention and Treatment of Glucocorticoid‐Induced Osteoporosis

Humphrey,

Russell,

Danila

et al. 2023

Arthritis & Rheumatology

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ObjectiveThe objective is to update recommendations for prevention and treatment of glucocorticoid‐induced osteoporosis (GIOP) for patients with rheumatic or nonrheumatic conditions receiving >3 months treatment with glucocorticoids (GCs) ≥2.5 mg daily.MethodsAn updated systematic literature review was performed for clinical questions on nonpharmacologic, pharmacologic treatments, discontinuation of medications, and sequential therapy. Grading of Recommendations Assessment, Development and Evaluation approach was used to rate the certainty of evidence. A Voting Panel achieved ≥70% consensus on the direction (for or against) and strength (strong or conditional) of recommendations.ResultsFor adults beginning or continuing >3 months of GC treatment, we strongly recommend as soon as possible after initiation of GCs, initial assessment of fracture risks with clinical fracture assessment, bone mineral density with vertebral fracture assessment or spinal x‐ray, and Fracture Risk Assessment Tool if ≥40 years old. For adults at medium, high, or very high fracture risk, we strongly recommend pharmacologic treatment. Choice of oral or intravenous bisphosphonates, denosumab, or parathyroid hormone analogs should be made by shared decision‐making. Anabolic agents are conditionally recommended as initial therapy for those with high and very high fracture risk. Recommendations are made for special populations, including children, people with organ transplants, people who may become pregnant, and people receiving very high‐dose GC treatment. New recommendations for both discontinuation of osteoporosis therapy and sequential therapies are included.ConclusionThis guideline provides direction for clinicians and patients making treatment decisions for management of GIOP. These recommendations should not be used to limit or deny access to therapies.

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Bone loss after denosumab discontinuation is prevented by alendronate and zoledronic acid but not risedronate: a retrospective study

Cited by 25 publications

References 49 publications

What’s New in Osteoporosis and Fragility Fractures

What’s New in Osteoporosis and Fragility Fractures

Three-year effect of bisphosphonates on bone mineral density after denosumab withdrawal: observations from a real-world study

2022 American College of Rheumatology Guideline for the Prevention and Treatment of Glucocorticoid‐Induced Osteoporosis

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