Clinical Features of 24 Patients With Rebound-Associated Vertebral Fractures After Denosumab Discontinuation: Systematic Review and Additional Cases
Clinical Features of 24 Patients With Rebound-Associated Vertebral Fractures After Denosumab Discontinuation: Systematic Review and Additional Cases
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DOI：
10.1002/jbmr.3110
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发表时间：
2017-06-01
影响因子：
6.2
通讯作者：
Lamy, Olivier
中科院分区：
文献类型：
--
作者：
Anastasilakis, Athanasios D.;Polyzos, Stergios A.;Lamy, Olivier
我们的目的是研究停药后椎体骨折患者的临床和影像特征。为此，我们进行了计算机化的高级文献搜索，确定了13个已发表的病例，此外，我们还包括了来自我们中心的另外11个新病例。对2 4例绝经后妇女(S)停药后发生椎体骨折的临床资料进行了分析。平均每个患者有4.7个骨折。最常见的受累椎骨是T12和L1。所有骨折均发生在最后一次注射地诺单抗后8至16个月。83%的患者治疗很简单，而33%的患者有普遍的脊椎骨折。5名患者(23%)同时接受芳香酶抑制剂治疗。当患者按治疗年限划分时，任意中断2年的患者，平均+/-扫描电子显微镜骨折3.2+/-0.7vs.5.2+/-1.4时，p=0.055。5例患者行椎体成形术，所有患者均出现更多临床椎体骨折。我们得出结论，脊柱骨折(S)在大多数患者停药后是多次的，而且他们发生在最后一次服药效果耗尽后的几个月。因此，患者不应推迟或遗漏Denosumab剂量。骨折是典型的骨质疏松性骨折，位于下胸椎和上腰椎。对于此类患者，椎体成形术是一种不成功的治疗策略。(C)2017美国骨与矿物研究学会。
We aimed to study the clinical and imaging characteristics of patients sustaining vertebral fractures after denosumab discontinuation. For this purpose, we conducted a computerized advanced literature search that identified 13 published cases, and we additionally included another 11 new cases from our centers. Twenty-four postmenopausal women with vertebral fracture(s) after denosumab discontinuation, experiencing 112 fractures in total, were analyzed. The mean number of fractures per patient was 4.7. The most commonly affected vertebrae were T12 and L1. All fractures occurred 8 to 16 months after the last denosumab injection. Eighty-three percent of the patients were treatment naive, whereas 33% had prevalent vertebral fractures. Five (23%) patients were on concurrent aromatase inhibitor treatment. When patients were divided according to treatment duration with an arbitrary cut-off of 2 years, those with 2 years (mean +/- SEM fractures 3.2 +/- 0.7 versus 5.2 +/- 1.4, p = 0.055). Vertebroplasty was used in 5 patients, resulting in additional clinical vertebral fractures in all cases. We conclude that vertebral fracture(s) after denosumab discontinuation are in the majority of patients multiples, and they occur a few months after the effect of the last dose is depleted. Therefore, patients should not delay or omit denosumab doses. Fractures are typically osteoporotic, located at the lower thoracic and the upper lumbar spine. Vertebroplasty is an unsuccessful treatment strategy for such patients. (C) 2017 American Society for Bone and Mineral Research.