地舒单抗停药后发生的骨质流失可被阿仑膦酸钠、唑来膦酸预防，但不能被利塞膦酸钠预防：一项回顾性研究。
Bone loss after denosumab discontinuation is prevented by alendronate and zoledronic acid but not risedronate: a retrospective study.
机构信息
Hospital for Special Surgery, New York, NY, USA.
Department of Orthopedic Surgery, Phramongkutkloa Hospital, Ratchathewi, Bangkok, Thailand.
出版信息
Osteoporos Int. 2023 Mar;34(3):573-584. doi: 10.1007/s00198-022-06648-9. Epub 2023 Jan 5.
UNLABELLED
A retrospective study of 121 patients who stopped denosumab (Dmab) then received no treatment (NT), risedronate (RIS), alendronate (ALN), or zoledronic acid (ZOL). Bone density (spine and hip) during and after Dmab discontinuation was measured. Treatment with ALN or ZOL, not NT and RIS, mitigated BMD loss after Dmab discontinuation.
INTRODUCTION
Denosumab (Dmab) discontinuation is associated with bone loss and multiple vertebral fractures. The purpose was to compare bone mineral density (BMD) change in patients following Dmab discontinuation with no subsequent treatment (NT) and three bisphosphonate (BP) treatments: risedronate (RIS), alendronate (ALN), and zoledronic acid (ZOL).
METHODS
In a review of 121 patients aged 71.2 ± 8.1 years, discontinuing Dmab (mean 5.4 doses), 33 received NT and 88 received BP (22 RIS; 34 ALN; 32 ZOL). BMD change after 1 year was compared between groups at the lumbar spine (LS), femoral neck (FN), and total hip (TH). Risk factors for bone loss after Dmab discontinuation were compared between groups and incidence of vertebral fractures was determined.
RESULTS
Following Dmab discontinuation, LS mean change (g/cm; 95% CI) was for NT: - 0.041 (- 0.062 to - 0.021); RIS: - 0.035 (- 0.052 to - 0.017); ALN: - 0.005 (- 0.020 to 0.009); and ZOL: - 0.009 (- 0.025 to 0.008). Differences in LS were found between NT and ALN (p = 0.015), and NT and ZOL (p=0.037), but not between NT and RIS. The only significant difference in TH was found between NT and ZOL (p 0.034) with no group differences in FN. BMD gains during Dmab treatment were associated with BMD loss after Dmab discontinuation. In a subset, discontinuation after Dmab treatment (> 5 doses) followed by ALN (n = 22) and ZOL (n = 11) showed no difference in BMD. Five of 7 vertebral fractures occurred after Dmab discontinuation in NT.
CONCLUSION
Subsequent treatment with ALN or ZOL but not NT and RIS mitigates BMD loss after Dmab discontinuation.
目的
比较在停止使用 denosumab（Dmab）后未接受任何治疗（NT）以及接受三种双膦酸盐（BP）治疗（risedronate[RIS]、alendronate[ALN]和zoledronic acid[ZOL]）的患者的骨密度（BMD）变化。
方法
在对 121 名年龄为 71.2±8.1 岁的患者进行回顾性研究中，这些患者停止使用 Dmab（平均 5.4 剂），其中 33 名患者接受 NT，88 名患者接受 BP 治疗（22 名 RIS；34 名 ALN；32 名 ZOL）。比较各组在腰椎（LS）、股骨颈（FN）和全髋（TH）的 1 年后 BMD 变化。比较各组之间 Dmab 停药后骨丢失的危险因素，并确定椎体骨折的发生率。
结果
在停止使用 Dmab 后，LS 的平均变化（g/cm；95%CI）为 NT：-0.041（-0.062 至-0.021）；RIS：-0.035（-0.052 至-0.017）；ALN：-0.005（-0.020 至 0.009）；ZOL：-0.009（-0.025 至 0.008）。在 NT 与 ALN 之间（p=0.015）和 NT 与 ZOL 之间（p=0.037）发现 LS 存在差异，但在 NT 与 RIS 之间没有差异。TH 仅存在 NT 与 ZOL 之间的显著差异（p<0.034），而 FN 组之间无差异。在 Dmab 治疗期间的 BMD 增加与 Dmab 停药后的 BMD 损失相关。在亚组中，停用 Dmab 治疗（>5 剂）后继续使用 ALN（n=22）和 ZOL（n=11）的患者的 BMD 无差异。在 NT 组中有 5 例椎体骨折发生在 Dmab 停药后。
结论
随后使用 ALN 或 ZOL 治疗，但不是 NT 和 RIS，可减轻 Dmab 停药后的 BMD 丢失。
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