Multiple vertebral fractures following discontinuation of denosumab treatment: ten clinical cases report

Fernández, Elisa; Nuñez, Diego; Hernán, Gema Bonilla; Monjo, I.; Carazo, Sara; Pineda, Miguel Bernad; Criado, Alejandro; Acín, Pilar Aguado

doi:10.1016/j.reumae.2018.11.021

Cited by 7 publications

(4 citation statements)

References 11 publications

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“…Vertebroplasty has also been identified as another factor setting patients who discontinue Dmab at risk for VFs, especially at the adjacent vertebrae [ 24 , 44 , 52 ]. It is possible that bone material properties are compromised even in intact vertebrae, rendering them prone to fracture when increased compressing forces are exerted upon them by the neighboring cemented vertebrae.…”

Section: Factors Predisposing To Bone Loss and Fractures Followingmentioning

confidence: 99%

Denosumab Discontinuation and the Rebound Phenomenon: A Narrative Review

Anastasilakis

Makras

Yavropoulou

et al. 2021

JCM

112

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Denosumab is a potent antiresorptive agent that substantially increases bone mineral density and reduces fracture rates at all skeletal sites for as long as it is administered. However, its favorable skeletal effects reverse quickly upon its discontinuation, because of a vast increase of osteoclast number and activity, which leads to a subsequent profound increase of bone turnover above pre-treatment values, a phenomenon commonly described as “rebound phenomenon”. More importantly, most patients experience rapid, profound bone loss due to this burst of bone resorption that may lead in a minority of these patients to occurrence of fractures, especially multiple vertebral fractures. Therefore, subsequent antiresorptive treatment is mandatory, although the optimal regimen is yet to be clarified. In the present review, we outline what is currently known regarding the negative effects of denosumab discontinuation on different aspects of bone status, the factors that may affect them, and strategies to prevent them.

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Section: Factors Predisposing To Bone Loss and Fractures Followingmentioning

confidence: 99%

Denosumab Discontinuation and the Rebound Phenomenon: A Narrative Review

Anastasilakis

Makras

Yavropoulou

et al. 2021

JCM

112

View full text Add to dashboard Cite

show abstract

“…Notably, the effectiveness of denosumab is limited to the duration of treatment, unlike bisphosphonates, which are known for their residual anti-resorptive efficacy after treatment is discontinued. Sequential bisphosphonate treatment is mandatory after discontinuing denosumab to prevent accelerated bone loss and vertebral fractures [68,69]. Romoszumab can increase bone density via another mode of action.…”

Section: Treatmentmentioning

confidence: 99%

Bone health in patients with inflammatory bowel disease

Kreienbuehl,

Rogler,

Emanuel

et al. 2024

Swiss Med Wkly

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Patients with inflammatory bowel disease (IBD) are prone to reduced bone mineral density and elevated overall fracture risk. Osteopenia affects up to 40% of patients with IBD (high regional variability). Besides disease activity, IBD specialists must consider possible side effects of medication and the presence of associated diseases and extraintestinal manifestations. Osteopenia and osteoporosis remain frequent problems in patients with IBD and are often underestimated because of widely differing screening and treatment practices. Malnutrition, chronic intestinal inflammation and corticosteroid intake are the major pathophysiological factors contributing to osteoporosis. Patients with IBD are screened for osteoporosis using dual-energy X-ray absorptiometry (DXA), which is recommended for all patients with a prolonged disease course of more than three months, with repeated corticosteroid administration, aged >40 years with a high FRAX risk score or aged <40 years with multiple risk factors. From a therapeutic perspective, besides good disease control, vitamin D supplementation and glucocorticoid sparing, several specific osteological options are available: bisphosphonates, receptor activator of nuclear factor kappa-B ligand (RANKL) inhibitors (denosumab), parathyroid hormone (PTH) analogues and selective estrogen receptor modulators. This review provides an overview of the pathophysiology, diagnosis, prevention and treatment of IBD-associated bone loss.

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“…In patients with RVFx, vertebroplasty and kyphoplasty are strongly contraindicated, as an increased risk of additional, most often multiple, fractures of the adjacent vertebrae has been described in several case series and case reports [ 6 , 54 , 55 , 56 , 57 ]. It is hypothesized that in patients discontinuing Dmab, even the intact vertebrae are seriously weakened due to the highly accelerated bone turnover and are susceptible to fractures [ 6 ].…”

Section: Managementmentioning

confidence: 99%

Similarities and Differences in the Management of Patients with Osteoporotic Vertebral Fractures and Those with Rebound-Associated Vertebral Fractures Following Discontinuation of Denosumab

Anastasilakis,

Makras,

Paccou

et al. 2023

JCM

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Rebound-associated vertebral fractures (RVFx) following denosumab discontinuation are typically multiple, are commonly associated with acute sharp pain, increase the risk of imminent fractures, and are pathogenetically different from common osteoporotic vertebral fractures (VFx). A clinically relevant question is whether patients with RVFx should be managed differently from patients with osteoporotic VFx. To address this question, we performed a systematic search of the PubMed database, and we reviewed current evidence on the optimal management of patients with RVFx. For pain relief of patients with RVFx, potent analgesics, often opioids, are essential. Information on the effectiveness of braces in these patients is scarce. Vertebroplasty and kyphoplasty are strongly contraindicated as they confer a substantial risk for new VFx. Exercise may be helpful, but again evidence is lacking. In contrast to patients with osteoporotic VFx, in whom initial treatment with bone-forming agents is recommended, patients with RVFx should initiate treatment with potent antiresorptives. To summarize, patients who have sustained RVFx following denosumab discontinuation are at a very high risk for new fractures, especially VFx. The management of such patients requires a multidisciplinary approach that should not be restricted to pain relief and administration of antiosteoporotic medication, but should also include back protection, early mobilization, and appropriate exercise.

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Multiple vertebral fractures following discontinuation of denosumab treatment: ten clinical cases report

Cited by 7 publications

References 11 publications

Denosumab Discontinuation and the Rebound Phenomenon: A Narrative Review

Denosumab Discontinuation and the Rebound Phenomenon: A Narrative Review

Bone health in patients with inflammatory bowel disease

Similarities and Differences in the Management of Patients with Osteoporotic Vertebral Fractures and Those with Rebound-Associated Vertebral Fractures Following Discontinuation of Denosumab

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