Bone Health and Osteoporosis Unit, Mercer's Institute for Successful Ageing, St. James's Hospital.
Ir Med J. 2022 Mar 16;115(3):567.
Introduction Denosumab is commonly used to treat osteoporosis. However, discontinuation results in rebound bone loss and increased vertebral fracture risk. We report a clinical case series, illustrating the dilemma in deciding the best treatment should denosumab be stopped. Cases In eight patients aged 56-89 years, zolendronic acid after stopping denosumab resulted in BTM rises and BMD decline. In a 68-year-old, two years of oral bisphosphonate after three years of denosumab resulted in elevated bone turnover markers (BTM) and decline in bone mineral density (BMD), necessitating a switch to zoledronic acid. In a 79-year-old, two annual doses of zolendronic acid after three years of denosumab failed to suppress high BTM, with BMD dropping and denosumab being restarted. In a 60-year-old, on stopping denosumab after 10 years of oral bisphosphonate, BMD remained stable despite no further therapy. Conclusion Drug holidays are not an option with denosumab, with a risk of bone loss even on transitioning to bisphosphonates. Risk is greater with longer duration of treatment6 and may be mitigated by prior bisphosphonate use. Standard dose zoledronic acid does not prevent bone loss in a significant proportion of patients. BTM may help in monitoring treatment and need for further bisphosphonates.
介绍 地舒单抗常用于治疗骨质疏松症。然而，停药会导致骨丢失反弹和椎体骨折风险增加。我们报告了一系列临床病例，说明了在决定是否停止使用地舒单抗时的治疗方案，这是一个两难的选择。
病例 在 8 名年龄在 56-89 岁的患者中，唑来膦酸在停止使用地舒单抗后导致 BTM 升高和 BMD 下降。
在一名 68 岁的患者中，在停止使用地舒单抗三年后，接受了两年的口服双膦酸盐治疗，导致骨转换标志物 (BTM) 升高和骨密度 (BMD) 下降，需要转为使用唑来膦酸。
在一名 79 岁的患者中，在停止使用地舒单抗三年后，接受了两次唑来膦酸治疗，但未能抑制高 BTM，BMD 下降，再次开始使用地舒单抗。
在一名 60 岁的患者中，在停止使用地舒单抗 10 年后，尽管没有进一步治疗，BMD 仍保持稳定。
结论 地舒单抗不能停药，即使转换为双膦酸盐也有发生骨丢失的风险。治疗时间越长，风险越大，而先前使用双膦酸盐可能会降低风险。标准剂量的唑来膦酸并不能预防相当一部分患者的骨丢失。BTM 可能有助于监测治疗效果和是否需要进一步使用双膦酸盐。
