Risk factors for vertebral fractures and bone loss after denosumab discontinuation: A real-world observational study
Risk factors for vertebral fractures and bone loss after denosumab discontinuation: A real-world observational study
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DOI：
10.1016/j.bone.2020.115830
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发表时间：
2021-03-01
期刊：
影响因子：
4.1
通讯作者：
Lehmann, T.
中科院分区：
文献类型：
--
作者：
Everts-Graber, J.;Reichenbach, S.;Lehmann, T.
背景：在未服用双膦酸类药物(BPS)的情况下停用Denosumab与骨丢失和多发性椎体骨折有关。目的：确定Denosumab停用后骨丢失和椎体骨折的危险因素。方法：这项回顾性研究评估了219名骨质疏松症患者停用Denosumab治疗后接受唑来膦酸盐、其他BPS或选择性雌激素受体调节剂(SERM)治疗或不接受治疗的结果。分析停药后2年内骨折发生率、纵向骨密度(BMD)变化及骨转换指标(BTMS)。线性回归分析评估了年龄、BMI(kg/m(2))、Denosumab治疗持续时间、治疗前、既往骨折状态、基线T评分、糖皮质激素或芳香酶抑制剂的使用以及Denosumab治疗下的BMD增加。结果：171名女性在Denosumab停用后接受唑来磷酸钠治疗，26名没有后续治疗，22名接受其他治疗(其他BPS或SERM)。唑来膦酸盐与最少的椎体骨折有关(风险比0.16，p=0.02)，随后的所有治疗都在一定程度上保留了所有部位的骨密度。较高的BMD丢失与较年轻的年龄、较低的BMI、较长时间的地诺单抗治疗、缺乏先前的抗吸收治疗以及在使用地诺单抗治疗的情况下骨密度增加有关。BTM水平与Denosumab治疗时间和全髋部骨丢失相关，但与腰椎无关。结论：与没有后续治疗的患者相比，Denosumab治疗后，唑来磷酸钠导致的椎体骨折较少。此外，BMD的丢失取决于Denosumab治疗持续时间、年龄、既往BP治疗以及接受Denosumab治疗后的BMD增加，而BTM水平与全髋部的骨丢失和Denosumab治疗持续时间相关。
Background: Denosumab discontinuation without subsequent bisphosphonates (BPs) is associated with bone loss and multiple vertebral fractures.Objective: Identifying risk factors for bone loss and vertebral fractures after denosumab discontinuation.Methods: This retrospective study measured the outcome of 219 women with osteoporosis who discontinued denosumab treatment and received subsequent treatment with zoledronate, other BPs or a selective estrogen receptor modulator (SERM), or no therapy. Fracture rate, longitudinal bone mineral density (BMD) changes and bone turnover markers (BTMs) within 2 years after denosumab discontinuation were analysed. Linear regression analysis evaluated loss of BMD and age, BMI (kg/m(2)), denosumab treatment duration, pre-treatment, prior fracture state, baseline T-scores, use of glucocorticoids or aromatase inhibitors and BMD gains under denosumab therapy.Results: 171 women received zoledronate after denosumab discontinuation, 26 had no subsequent treatment and 22 received other therapies (other BPs or a SERM). Zoledronate was associated with the fewest vertebral fractures (hazard ratio 0.16, p = 0.02) and all subsequent therapies retained BMD at all sites to some extent. Higher BMD loss was associated with younger age, lower BMI, longer denosumab treatment, lack of prior antiresorptive treatment and BMD gain under denosumab treatment. BTM levels correlated with denosumab treatment duration and bone loss at the total hip, but not the lumbar spine.Conclusions: Compared to no subsequent therapy, zoledronate was associated with fewer vertebral fractures after denosumab. Further, BMD loss depended on denosumab treatment duration, age, prior BP therapy and BMD gain under denosumab therapy, whereas BTM levels were associated with bone loss at the total hip and denosumab treatment duration.