Osteoporosis Clinical Research Program, University of Wisconsin, 2870 University Avenue, Suite 100, Madison, WI, 53705, USA.
Merck Research Laboratories, Merck & Co., Inc., Kenilworth, NJ, USA.
Osteoporos Int. 2018 Apr;29(4):999-1002. doi: 10.1007/s00198-018-4385-0. Epub 2018 Feb 18.
Case reports of women sustaining multiple vertebral fractures (VF) soon afterdenosumab discontinuation are accumulating.
We report a woman with five new vertebral fractures in ~8 months following discontinuation of long-term odanacatib (ODN), an experimental cathepsin K inhibitor.
DXA examination demonstrated an ~12% decline in bone mineral density (BMD) and ~9% decline in trabecular bone score (TBS) since ODN discontinuation. Laboratory evaluation did not reveal a secondary cause of bone loss.
This case mimics observations following denosumab discontinuation, but, to our knowledge, is the first reported with ODN and the first documenting substantial decline in TBS. While not directly clinically relevant as ODN is no longer being developed, this case raises the possibility that a syndrome of multiple vertebral fractures could follow discontinuation of various potent osteoporosis therapies that produce major BMD increases but do not have persisting bone effects (i.e., all non-bisphosphonates). Use of antiresorptive therapies to prevent rapid bone loss following discontinuation of potent bone active agents seems appropriate. Identification of those patients who could be at risk for the multiple VF syndrome is needed.
越来越多的病例报告显示，在停止使用地舒单抗后，女性会很快出现多处椎体骨折（VF）。
我们报告了一例女性在停止长期使用奥达那曲肽（ODN）后约 8 个月内出现 5 处新的椎体骨折，ODN 是一种实验性组织蛋白酶 K 抑制剂。
DXA 检查显示，自停止使用 ODN 后，骨密度（BMD）下降了约 12%，小梁骨评分（TBS）下降了约 9%。实验室评估未发现骨丢失的继发原因。
本例类似于地舒单抗停药后的观察结果，但据我们所知，这是首例使用 ODN 报告的病例，也是首例记录到 TBS 明显下降的病例。虽然由于 ODN 不再开发，因此在临床上并不直接相关，但本例提示，在停止使用各种能显著增加骨密度但没有持续骨效应的强效骨质疏松治疗药物（即所有非双膦酸盐类药物）后，可能会出现多发椎体骨折综合征。在停止使用强效骨活性药物后，使用抗吸收治疗来预防快速骨丢失似乎是合适的。需要确定那些可能有多发 VF 综合征风险的患者。
