Anastasilakis Athanasios D, Makras Polyzois, Paccou Julien, Bisbinas Ilias, Polyzos Stergios A, Papapoulos Socrates E
Department of Endocrinology, 424 Military General Hospital, 564 29 Thessaloniki, Greece.
Department of Endocrinology and Diabetes, 251 Hellenic Air Force & VA General Hospital, 115 25 Athens, Greece.
J Clin Med. 2023 Sep 10;12(18):5874. doi: 10.3390/jcm12185874.
Rebound-associated vertebral fractures (RVFx) following denosumab discontinuation are typically multiple, are commonly associated with acute sharp pain, increase the risk of imminent fractures, and are pathogenetically different from common osteoporotic vertebral fractures (VFx). A clinically relevant question is whether patients with RVFx should be managed differently from patients with osteoporotic VFx. To address this question, we performed a systematic search of the PubMed database, and we reviewed current evidence on the optimal management of patients with RVFx. For pain relief of patients with RVFx, potent analgesics, often opioids, are essential. Information on the effectiveness of braces in these patients is scarce. Vertebroplasty and kyphoplasty are strongly contraindicated as they confer a substantial risk for new VFx. Exercise may be helpful, but again evidence is lacking. In contrast to patients with osteoporotic VFx, in whom initial treatment with bone-forming agents is recommended, patients with RVFx should initiate treatment with potent antiresorptives. To summarize, patients who have sustained RVFx following denosumab discontinuation are at a very high risk for new fractures, especially VFx. The management of such patients requires a multidisciplinary approach that should not be restricted to pain relief and administration of antiosteoporotic medication, but should also include back protection, early mobilization, and appropriate exercise.
地诺单抗停用后发生的与反弹相关的椎体骨折（RVFx）通常为多发性，常伴有急性剧痛，增加了近期骨折的风险，并且在发病机制上与常见的骨质疏松性椎体骨折（VFx）不同。一个具有临床相关性的问题是，RVFx患者的管理是否应与骨质疏松性VFx患者不同。为解决这个问题，我们对PubMed数据库进行了系统检索，并回顾了有关RVFx患者最佳管理的现有证据。对于RVFx患者的疼痛缓解，强效镇痛药（通常为阿片类药物）至关重要。关于支具对这些患者有效性的信息很少。强烈禁止进行椎体成形术和后凸成形术，因为它们会带来新的椎体骨折的重大风险。运动可能会有帮助，但同样缺乏证据。与推荐使用成骨药物进行初始治疗的骨质疏松性VFx患者不同，RVFx患者应开始使用强效抗吸收药物进行治疗。总之，地诺单抗停用后发生RVFx的患者发生新骨折的风险非常高，尤其是椎体骨折。对此类患者的管理需要多学科方法，不应仅限于疼痛缓解和抗骨质疏松药物的使用，还应包括背部保护、早期活动和适当的运动。
