Faculty of Biology and Medicine, University of Lausanne, 1015 Lausanne, Switzerland.
Interdisciplinary Center for Bone Diseases, Lausanne University Hospital and University of Lausanne, 1011 Lausanne, Switzerland; Service of Internal Medicine, Lausanne University Hospital and University of Lausanne, 1011 Lausanne, Switzerland.
Bone. 2023 Jul;172:116764. doi: 10.1016/j.bone.2023.116764. Epub 2023 Apr 14.
Denosumab discontinuation (DD) is associated with serum C-terminal X-linked telopeptides (sCTX) increase, bone mineral density (BMD) loss and vertebral fractures (VFs) risk increase. We compared clinical characteristics of women losing or not lumbar spine (LS) BMD one-year after DD, and their sCTX values at different time-points.
We included women from the ReoLaus cohort having received ≥2 denosumab 60 mg injections, with three BMD measurements on the same device (before (DXA1), at the end of denosumab treatment (DXA2), and one-year after (DXA3)) and sCTX measured at different time-points. Losers (LS DXA3-DXA2 > 2.8 %) and stable groups were compared.
63 postmenopausal women were included (mean age 64.2 ± 9.1 years, 7.9 ± 2.7 denosumab injections). 19 months after last denosumab injection, 65 % had lost LS BMD. Losers were younger, had lower BMD and higher sCTX before denosumab, received more injections and gained more BMD under denosumab, and had higher sCTX after DD. Same proportion of patients received bisphosphonates in both groups, but 11 (all in losers group) received ≥1 zoledronate infusion. Three women developed VFs in the losers group (none in the stable). Mean sCTX at 10 and 19 months were 590 ± 372 versus 221 ± 101, and 598 ± 324 versus 293 ± 157 ng/l, respectively (premenopausal range < 573 ng/l, p < 0.01 for both). LS BMD loss and sCTX levels measured at 10 and 19 months were correlated (r = 0.29, p = 0.01, and r = 0.16, p < 0.005).
Maintenance of BMD gained with denosumab is associated with sCTX in the low premenopausal range after DD. Whether this could be achieved by regular sCTX monitoring and adjustment of bisphosphonates doses or frequency administration needs to be confirmed by further studies.
地舒单抗停药（DD）与血清 C 端 X 连锁肽（sCTX）升高、骨密度（BMD）丢失和椎体骨折（VF）风险增加有关。我们比较了 DD 治疗后一年失去或未失去腰椎（LS）BMD 的女性的临床特征及其不同时间点 sCTX 值。
我们纳入了接受≥2 剂 60mg 地舒单抗治疗的 ReoLaus 队列中的女性，同一设备上有三次 BMD 测量（治疗前（DXA1）、地舒单抗治疗结束时（DXA2）和一年后（DXA3）），并在不同时间点测量 sCTX。比较失能组（LS DXA3-DXA2>2.8%）和稳定组。
纳入 63 例绝经后女性（平均年龄 64.2±9.1 岁，接受 7.9±2.7 次地舒单抗治疗）。末次地舒单抗注射后 19 个月，65%的女性 LS BMD 丢失。失能组更年轻，地舒单抗治疗前 BMD 更低，sCTX 更高，地舒单抗治疗期间接受了更多的注射，获得了更多的 BMD，停药后 sCTX 更高。两组中均有相同比例的患者接受了双膦酸盐治疗，但有 11 例（均在失能组）接受了≥1 次唑来膦酸输注。失能组有 3 例发生 VF（稳定组无）。失能组的平均 sCTX 在 10 个月和 19 个月时分别为 590±372 与 221±101ng/L，598±324 与 293±157ng/L（绝经前范围<573ng/L，均 p<0.01）。10 个月和 19 个月时 LS BMD 丢失与 sCTX 水平相关（r=0.29，p=0.01，r=0.16，p<0.005）。
DD 后 sCTX 处于低绝经前范围与地舒单抗获得的 BMD 维持有关。通过定期 sCTX 监测和调整双膦酸盐剂量或增加给药频率是否可以实现这一点，需要进一步的研究来证实。
