Spontaneous vertebral fractures after denosumab discontinuation: A case collection and review of the literature.
Identifieur interne : 000056 ( Main/Exploration ); précédent : 000055; suivant : 000057Spontaneous vertebral fractures after denosumab discontinuation: A case collection and review of the literature.
Auteurs : Helena Florez [Espagne] ; Julio Ramírez [Espagne] ; Ana Monegal [Espagne] ; Núria Gua Abens [Espagne] ; Pilar Peris [Espagne]Source :
- Seminars in arthritis and rheumatism [ 1532-866X ] ; 2019.
Descripteurs français
- KwdFr :
- MESH :
- diagnostic : Fractures du rachis, Fractures ostéoporotiques.
- usage thérapeutique : Agents de maintien de la densité osseuse, Dénosumab.
- Abstention thérapeutique, Adulte d'âge moyen, Femelle, Humains, Sujet âgé.
English descriptors
- KwdEn :
- MESH :
- chemical , therapeutic use : Bone Density Conservation Agents, Denosumab.
- diagnosis : Osteoporotic Fractures, Spinal Fractures.
- Aged, Female, Humans, Middle Aged, Withholding Treatment.
Abstract
OBJECTIVE
Denosumab is an antiresorptive drug with demonstrated efficacy in the treatment of osteoporosis. However, discontinuation of this agent is associated with increased bone turnover and rapid bone loss, and more recently, with the development of vertebral fractures (VF) in some patients. Therefore, the aim of the study was to analyze the clinical characteristics, bone metabolism parameters and evolution of a group of patients who developed vertebral fractures after denosumab discontinuation. In addition, we reviewed the literature on this subject.
METHODS
During a period of 28 months (September 2015-January 2018) 7 women presenting spontaneous vertebral fractures after denosumab discontinuation were attended in the Rheumatology Department of our centre. We analyzed their clinical characteristics, bone metabolism parameters and evolution and reviewed the literature related to this subject.
RESULTS
The patients had received denosumab during 24-58 months (median 38), and developed a median of 5 VF per patient at 8-20 months (median 10) since the last dose of denosumab. Only 2 patients presented previous VF, and most (5 patients) received previous bisphosphonate treatment. After VF all restarted antiosteoporotic treatment with no further fractures during follow-up (median 19 months).
CONCLUSIONS
In this short series, previous bisphosphonate treatment does not seem to be a protective factor for the development of VF. The possible development of VF following discontinuation of denosumab must be taken into account in the clinical practice of physicians and dentists. Nonetheless, further studies are needed to improve the identification of patients at risk and the most adequate sequential treatment options.
DOI: 10.1016/j.semarthrit.2019.02.007
PubMed: 30826108
Affiliations:
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Electronic address: hflorez@clinic.cat.</nlm:affiliation><country xml:lang="fr">Espagne</country><wicri:regionArea>Department of Rheumatology, Hospital Clinic, University of Barcelona, Villarroel 170, 08036 Barcelona</wicri:regionArea><placeName><region nuts="2" type="communauté">Catalogne</region></placeName></affiliation></author><author><name sortKey="Ramirez, Julio" sort="Ramirez, Julio" uniqKey="Ramirez J" first="Julio" last="Ramírez">Julio Ramírez</name><affiliation wicri:level="2"><nlm:affiliation>Department of Rheumatology, Hospital Clinic, University of Barcelona, Villarroel 170, 08036 Barcelona, Spain.</nlm:affiliation><country xml:lang="fr">Espagne</country><wicri:regionArea>Department of Rheumatology, Hospital Clinic, University of Barcelona, Villarroel 170, 08036 Barcelona</wicri:regionArea><placeName><region nuts="2" type="communauté">Catalogne</region></placeName></affiliation></author><author><name sortKey="Monegal, Ana" sort="Monegal, Ana" uniqKey="Monegal A" first="Ana" last="Monegal">Ana Monegal</name><affiliation wicri:level="2"><nlm:affiliation>Department of Rheumatology, Hospital Clinic, University of Barcelona, Villarroel 170, 08036 Barcelona, Spain.</nlm:affiliation><country xml:lang="fr">Espagne</country><wicri:regionArea>Department of Rheumatology, Hospital Clinic, University of Barcelona, Villarroel 170, 08036 Barcelona</wicri:regionArea><placeName><region nuts="2" type="communauté">Catalogne</region></placeName></affiliation></author><author><name sortKey="Gua Abens, Nuria" sort="Gua Abens, Nuria" uniqKey="Gua Abens N" first="Núria" last="Gua Abens">Núria Gua Abens</name><affiliation wicri:level="2"><nlm:affiliation>Department of Rheumatology, Hospital Clinic, University of Barcelona, Villarroel 170, 08036 Barcelona, Spain.</nlm:affiliation><country xml:lang="fr">Espagne</country><wicri:regionArea>Department of Rheumatology, Hospital Clinic, University of Barcelona, Villarroel 170, 08036 Barcelona</wicri:regionArea><placeName><region nuts="2" type="communauté">Catalogne</region></placeName></affiliation></author><author><name sortKey="Peris, Pilar" sort="Peris, Pilar" uniqKey="Peris P" first="Pilar" last="Peris">Pilar Peris</name><affiliation wicri:level="2"><nlm:affiliation>Department of Rheumatology, Hospital Clinic, University of Barcelona, Villarroel 170, 08036 Barcelona, Spain.</nlm:affiliation><country xml:lang="fr">Espagne</country><wicri:regionArea>Department of Rheumatology, Hospital Clinic, University of Barcelona, Villarroel 170, 08036 Barcelona</wicri:regionArea><placeName><region nuts="2" type="communauté">Catalogne</region></placeName></affiliation></author></analytic><series><title level="j">Seminars in arthritis and rheumatism</title><idno type="eISSN">1532-866X</idno><imprint><date when="2019" type="published">2019</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Aged (MeSH)</term><term>Bone Density Conservation Agents (therapeutic use)</term><term>Denosumab (therapeutic use)</term><term>Female (MeSH)</term><term>Humans (MeSH)</term><term>Middle Aged (MeSH)</term><term>Osteoporotic Fractures (diagnosis)</term><term>Spinal Fractures (diagnosis)</term><term>Withholding Treatment (MeSH)</term></keywords><keywords scheme="KwdFr" xml:lang="fr"><term>Abstention thérapeutique (MeSH)</term><term>Adulte d'âge moyen (MeSH)</term><term>Agents de maintien de la densité osseuse (usage thérapeutique)</term><term>Dénosumab (usage thérapeutique)</term><term>Femelle (MeSH)</term><term>Fractures du rachis (diagnostic)</term><term>Fractures ostéoporotiques (diagnostic)</term><term>Humains (MeSH)</term><term>Sujet âgé (MeSH)</term></keywords><keywords scheme="MESH" type="chemical" qualifier="therapeutic use" xml:lang="en"><term>Bone Density Conservation Agents</term><term>Denosumab</term></keywords><keywords scheme="MESH" qualifier="diagnosis" xml:lang="en"><term>Osteoporotic Fractures</term><term>Spinal Fractures</term></keywords><keywords scheme="MESH" qualifier="diagnostic" xml:lang="fr"><term>Fractures du rachis</term><term>Fractures ostéoporotiques</term></keywords><keywords scheme="MESH" qualifier="usage thérapeutique" xml:lang="fr"><term>Agents de maintien de la densité osseuse</term><term>Dénosumab</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Aged</term><term>Female</term><term>Humans</term><term>Middle Aged</term><term>Withholding Treatment</term></keywords><keywords scheme="MESH" xml:lang="fr"><term>Abstention thérapeutique</term><term>Adulte d'âge moyen</term><term>Femelle</term><term>Humains</term><term>Sujet âgé</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p><b>OBJECTIVE</b></p><p>Denosumab is an antiresorptive drug with demonstrated efficacy in the treatment of osteoporosis. However, discontinuation of this agent is associated with increased bone turnover and rapid bone loss, and more recently, with the development of vertebral fractures (VF) in some patients. Therefore, the aim of the study was to analyze the clinical characteristics, bone metabolism parameters and evolution of a group of patients who developed vertebral fractures after denosumab discontinuation. In addition, we reviewed the literature on this subject.</p></div><div type="abstract" xml:lang="en"><p><b>METHODS</b></p><p>During a period of 28 months (September 2015-January 2018) 7 women presenting spontaneous vertebral fractures after denosumab discontinuation were attended in the Rheumatology Department of our centre. We analyzed their clinical characteristics, bone metabolism parameters and evolution and reviewed the literature related to this subject.</p></div><div type="abstract" xml:lang="en"><p><b>RESULTS</b></p><p>The patients had received denosumab during 24-58 months (median 38), and developed a median of 5 VF per patient at 8-20 months (median 10) since the last dose of denosumab. Only 2 patients presented previous VF, and most (5 patients) received previous bisphosphonate treatment. After VF all restarted antiosteoporotic treatment with no further fractures during follow-up (median 19 months).</p></div><div type="abstract" xml:lang="en"><p><b>CONCLUSIONS</b></p><p>In this short series, previous bisphosphonate treatment does not seem to be a protective factor for the development of VF. The possible development of VF following discontinuation of denosumab must be taken into account in the clinical practice of physicians and dentists. Nonetheless, further studies are needed to improve the identification of patients at risk and the most adequate sequential treatment options.</p></div></front></TEI><pubmed><MedlineCitation Status="MEDLINE" Owner="NLM"><PMID Version="1">30826108</PMID><DateCompleted><Year>2020</Year><Month>06</Month><Day>30</Day></DateCompleted><DateRevised><Year>2020</Year><Month>06</Month><Day>30</Day></DateRevised><Article PubModel="Print-Electronic"><Journal><ISSN IssnType="Electronic">1532-866X</ISSN><JournalIssue CitedMedium="Internet"><Volume>49</Volume><Issue>2</Issue><PubDate><Year>2019</Year><Month>10</Month></PubDate></JournalIssue><Title>Seminars in arthritis and rheumatism</Title><ISOAbbreviation>Semin Arthritis Rheum</ISOAbbreviation></Journal><ArticleTitle>Spontaneous vertebral fractures after denosumab discontinuation: A case collection and review of the literature.</ArticleTitle><Pagination><MedlinePgn>197-203</MedlinePgn></Pagination><ELocationID EIdType="pii" ValidYN="Y">S0049-0172(18)30700-5</ELocationID><ELocationID EIdType="doi" ValidYN="Y">10.1016/j.semarthrit.2019.02.007</ELocationID><Abstract><AbstractText Label="OBJECTIVE">Denosumab is an antiresorptive drug with demonstrated efficacy in the treatment of osteoporosis. However, discontinuation of this agent is associated with increased bone turnover and rapid bone loss, and more recently, with the development of vertebral fractures (VF) in some patients. Therefore, the aim of the study was to analyze the clinical characteristics, bone metabolism parameters and evolution of a group of patients who developed vertebral fractures after denosumab discontinuation. In addition, we reviewed the literature on this subject.</AbstractText><AbstractText Label="METHODS">During a period of 28 months (September 2015-January 2018) 7 women presenting spontaneous vertebral fractures after denosumab discontinuation were attended in the Rheumatology Department of our centre. We analyzed their clinical characteristics, bone metabolism parameters and evolution and reviewed the literature related to this subject.</AbstractText><AbstractText Label="RESULTS">The patients had received denosumab during 24-58 months (median 38), and developed a median of 5 VF per patient at 8-20 months (median 10) since the last dose of denosumab. Only 2 patients presented previous VF, and most (5 patients) received previous bisphosphonate treatment. After VF all restarted antiosteoporotic treatment with no further fractures during follow-up (median 19 months).</AbstractText><AbstractText Label="CONCLUSIONS">In this short series, previous bisphosphonate treatment does not seem to be a protective factor for the development of VF. The possible development of VF following discontinuation of denosumab must be taken into account in the clinical practice of physicians and dentists. Nonetheless, further studies are needed to improve the identification of patients at risk and the most adequate sequential treatment options.</AbstractText><CopyrightInformation>Copyright © 2019 Elsevier Inc. All rights reserved.</CopyrightInformation></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Florez</LastName><ForeName>Helena</ForeName><Initials>H</Initials><AffiliationInfo><Affiliation>Department of Rheumatology, Hospital Clinic, University of Barcelona, Villarroel 170, 08036 Barcelona, Spain. Electronic address: hflorez@clinic.cat.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Ramírez</LastName><ForeName>Julio</ForeName><Initials>J</Initials><AffiliationInfo><Affiliation>Department of Rheumatology, Hospital Clinic, University of Barcelona, Villarroel 170, 08036 Barcelona, Spain.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Monegal</LastName><ForeName>Ana</ForeName><Initials>A</Initials><AffiliationInfo><Affiliation>Department of Rheumatology, Hospital Clinic, University of Barcelona, Villarroel 170, 08036 Barcelona, Spain.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Guañabens</LastName><ForeName>Núria</ForeName><Initials>N</Initials><AffiliationInfo><Affiliation>Department of Rheumatology, Hospital Clinic, University of Barcelona, Villarroel 170, 08036 Barcelona, Spain.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Peris</LastName><ForeName>Pilar</ForeName><Initials>P</Initials><AffiliationInfo><Affiliation>Department of Rheumatology, Hospital Clinic, University of Barcelona, Villarroel 170, 08036 Barcelona, Spain.</Affiliation></AffiliationInfo></Author></AuthorList><Language>eng</Language><PublicationTypeList><PublicationType UI="D002363">Case Reports</PublicationType><PublicationType UI="D016428">Journal Article</PublicationType><PublicationType UI="D016454">Review</PublicationType></PublicationTypeList><ArticleDate DateType="Electronic"><Year>2019</Year><Month>02</Month><Day>15</Day></ArticleDate></Article><MedlineJournalInfo><Country>United States</Country><MedlineTA>Semin Arthritis Rheum</MedlineTA><NlmUniqueID>1306053</NlmUniqueID><ISSNLinking>0049-0172</ISSNLinking></MedlineJournalInfo><ChemicalList><Chemical><RegistryNumber>0</RegistryNumber><NameOfSubstance UI="D050071">Bone Density Conservation Agents</NameOfSubstance></Chemical><Chemical><RegistryNumber>4EQZ6YO2HI</RegistryNumber><NameOfSubstance UI="D000069448">Denosumab</NameOfSubstance></Chemical></ChemicalList><CitationSubset>IM</CitationSubset><MeshHeadingList><MeshHeading><DescriptorName UI="D000368" MajorTopicYN="N">Aged</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D050071" MajorTopicYN="N">Bone Density Conservation Agents</DescriptorName><QualifierName UI="Q000627" MajorTopicYN="Y">therapeutic use</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D000069448" MajorTopicYN="N">Denosumab</DescriptorName><QualifierName UI="Q000627" MajorTopicYN="Y">therapeutic use</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D005260" MajorTopicYN="N">Female</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D006801" MajorTopicYN="N">Humans</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D008875" MajorTopicYN="N">Middle Aged</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D058866" MajorTopicYN="N">Osteoporotic Fractures</DescriptorName><QualifierName UI="Q000175" MajorTopicYN="Y">diagnosis</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D016103" MajorTopicYN="N">Spinal Fractures</DescriptorName><QualifierName UI="Q000175" MajorTopicYN="Y">diagnosis</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D028761" MajorTopicYN="N">Withholding Treatment</DescriptorName></MeshHeading></MeshHeadingList><KeywordList Owner="NOTNLM"><Keyword MajorTopicYN="Y">Denosumab treatment</Keyword><Keyword MajorTopicYN="Y">Drug holidays</Keyword><Keyword MajorTopicYN="Y">Osteoporosis</Keyword><Keyword MajorTopicYN="Y">Rebound</Keyword><Keyword MajorTopicYN="Y">Vertebral fractures</Keyword></KeywordList></MedlineCitation><PubmedData><History><PubMedPubDate PubStatus="received"><Year>2018</Year><Month>11</Month><Day>19</Day></PubMedPubDate><PubMedPubDate PubStatus="revised"><Year>2019</Year><Month>01</Month><Day>23</Day></PubMedPubDate><PubMedPubDate PubStatus="accepted"><Year>2019</Year><Month>02</Month><Day>11</Day></PubMedPubDate><PubMedPubDate PubStatus="pubmed"><Year>2019</Year><Month>3</Month><Day>4</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="medline"><Year>2020</Year><Month>7</Month><Day>1</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="entrez"><Year>2019</Year><Month>3</Month><Day>4</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate></History><PublicationStatus>ppublish</PublicationStatus><ArticleIdList><ArticleId IdType="pubmed">30826108</ArticleId><ArticleId IdType="pii">S0049-0172(18)30700-5</ArticleId><ArticleId IdType="doi">10.1016/j.semarthrit.2019.02.007</ArticleId></ArticleIdList></PubmedData></pubmed><affiliations><list><country><li>Espagne</li></country><region><li>Catalogne</li></region></list><tree><country name="Espagne"><region name="Catalogne"><name sortKey="Florez, Helena" sort="Florez, Helena" uniqKey="Florez H" first="Helena" last="Florez">Helena Florez</name></region><name sortKey="Gua Abens, Nuria" sort="Gua Abens, Nuria" uniqKey="Gua Abens N" first="Núria" last="Gua Abens">Núria Gua Abens</name><name sortKey="Monegal, Ana" sort="Monegal, Ana" uniqKey="Monegal A" first="Ana" last="Monegal">Ana Monegal</name><name sortKey="Peris, Pilar" sort="Peris, Pilar" uniqKey="Peris P" first="Pilar" last="Peris">Pilar Peris</name><name sortKey="Ramirez, Julio" sort="Ramirez, Julio" uniqKey="Ramirez J" first="Julio" last="Ramírez">Julio Ramírez</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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