Academic Unit of Bone Metabolism, The Mellanby Centre for Bone Research, University of Sheffield, Sheffield, UK.
Clinical Trials Research Unit, School of Health and Related Research, University of Sheffield, Sheffield, UK.
Osteoporos Int. 2018 Jun;29(6):1407-1417. doi: 10.1007/s00198-018-4460-6. Epub 2018 Mar 10.
The antiresorptive potency varies between different bisphosphonates. We investigated the effect of stopping oral bisphosphonate treatment for postmenopausal osteoporosis (ibandronate, alendronate, risedronate) on BTMs and BMD. After stopping treatment, all three groups showed an increase in BTMs and a decrease in hip BMD; however, none returned to pre-treatment baseline values.
Bisphosphonates (BPs) continue to suppress bone turnover markers (BTMs) after treatment has stopped, leading to the suggestion that a pause in treatment could be considered for low-risk patients. Indirect comparisons suggest that after cessation of treatment, the effects on bone may differ between drugs. We investigated the effects of stopping oral BP treatments for postmenopausal osteoporosis on BTMs and bone mineral density (BMD).
We studied postmenopausal osteoporotic women who had previously taken part in a 2-year randomised study of three oral BPs (ibandronate, alendronate, or risedronate). At the end of the study, women with hip BMD T-score > - 2.5 and considered clinically appropriate to discontinue treatment were invited to participate in a further 2-year observational study. Biochemical response was assessed using BTMs, and BMD was measured by dual-energy X-ray absorptiometry.
All BTMs increased after treatment withdrawal but remained below the pre-treatment baseline with less suppression of BTMs for the risedronate group compared to alendronate and ibandronate up to 48 weeks. There was no difference between the BP groups 96 weeks after stopping treatment. The change in BMD during the 96 weeks after stopping treatment was - 1.6% (95% CI - 1.9 to - 1.2, P < 0.001) for the total hip and - 0.6% (95% CI - 1.1 to - 0.2, P = 0.17) at the lumbar spine with no difference between the three BP groups (P = 0.85 and P = 0.48, respectively).
For all treatment groups, there was an increase in BTMs and a decrease in hip BMD after stopping BPs for 2 years; however, none returned to pre-treatment baseline values.
不同双膦酸盐的抗吸收作用存在差异。本研究旨在探讨绝经后骨质疏松症患者停止口服双膦酸盐（伊班膦酸钠、阿仑膦酸钠、利塞膦酸钠）治疗后，骨代谢标志物（BTMs）和骨密度（BMD）的变化。
本研究纳入了先前参加过为期 2 年的三种口服双膦酸盐（伊班膦酸钠、阿仑膦酸钠或利塞膦酸钠）随机对照研究的绝经后骨质疏松症女性患者。研究结束时，髋部 BMD T 评分> - 2.5 且临床认为适合停止治疗的患者被邀请参加进一步的为期 2 年的观察性研究。通过 BTMs 评估生化反应，通过双能 X 线吸收法测量 BMD。
所有 BTMs 在停药后均升高，但仍低于治疗前基线水平，利塞膦酸钠组较阿仑膦酸钠和伊班膦酸钠组的 BTM 抑制作用减弱，直至 48 周。停药 96 周后，各组间 BTM 无差异。停药后 96 周期间，BMD 的变化为总髋部 - 1.6%（95%CI - 1.9 至 - 1.2，P < 0.001），腰椎部 - 0.6%（95%CI - 1.1 至 - 0.2，P = 0.17），三组间无差异（P = 0.85 和 P = 0.48）。
对于所有治疗组，停止双膦酸盐治疗 2 年后，BTMs 升高，髋部 BMD 降低，但均未恢复至治疗前基线水平。
