Division of Endocrinology, Diabetes and Metabolism, Chaim Sheba Medical Center at Tel Hashomer, Ramat Gan, Israel.
Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Horm Metab Res. 2021 Mar;53(3):185-190. doi: 10.1055/a-1368-4218. Epub 2021 Feb 15.
Denosumab discontinuation is associated with rapid reversal of bone turnover suppression and with a considerable increase in fracture risk, including a risk for multiple vertebral fractures (MVF). Long-term follow-up of patients who sustained MVF after denosumab discontinuation has not been reported. This case-series was aimed to provide a long-term follow-up on the management and outcome of denosumab discontinuers who initially presented with multiple vertebral fractures. Denosumab discontinuers were identified from a computerized database of a large healthcare provider. Baseline and follow-up clinical, laboratory, and imaging data were obtained from the computerized database and electronic medical records. The post-denosumab discontinuers MVF patients consisted of 12 women aged 71±12. Osteoporotic fractures were prevalent before denosumab discontinuation in 6 of the patients. The majority received bisphosphonates before denosumab. MVF occurred 134±76 days after denosumab discontinuation. The patients were followed for a median of 36.5 (IQR 28.2, 42.5) months after MVF. Two patients passed-away. Two patients suffered recurrent vertebral fractures. Following MVF, patients were treated inconsistently with denosumab, teriparatide, oral, and intravenous bisphosphonates, in various sequences. Two patients underwent vertebroplasty/kyphoplasty. This long-term follow-up of real-world patients with MVF following denosumab discontinuation reveals that management is inconsistent, and recurrent fractures are not uncommon. It calls for clear management guidelines for patients with MVF after denosumab discontinuation and for special attention to this high-risk group.
地舒单抗停药与骨转换抑制的快速逆转相关，并显著增加骨折风险，包括多发椎体骨折（MVF）的风险。尚未报道地舒单抗停药后发生 MVF 的患者的长期随访情况。本病例系列旨在提供对地舒单抗停药后最初发生多发椎体骨折患者的管理和结局的长期随访。从大型医疗保健提供者的计算机数据库中确定了地舒单抗停药者。从计算机数据库和电子病历中获得了基线和随访的临床、实验室和影像学数据。地舒单抗停药后 MVF 患者包括 12 名年龄为 71±12 岁的女性。在 6 名患者中，地舒单抗停药前存在骨质疏松性骨折。大多数患者在使用地舒单抗之前接受过双膦酸盐治疗。MVF 在地舒单抗停药后 134±76 天发生。MVF 后，患者的中位随访时间为 36.5（IQR 28.2，42.5）个月。2 名患者死亡。2 名患者发生复发性椎体骨折。MVF 后，患者接受了地舒单抗、特立帕肽、口服和静脉用双膦酸盐的治疗，治疗方案不一致，且顺序不同。2 名患者接受了椎体成形术/椎体后凸成形术。对地舒单抗停药后发生 MVF 的真实世界患者的长期随访表明，管理不一致，且复发性骨折并不少见。这需要为地舒单抗停药后发生 MVF 的患者制定明确的管理指南，并特别关注这一高风险群体。
