학술논문
The Duration of Denosumab Treatment and the Efficacy of Zoledronate to Preserve Bone Mineral Density After Its Discontinuation
Clinical Research Article
Clinical Research Article
Document Type
Clinical report
Author
Source
Journal of Clinical Endocrinology & Metabolism. October 2021, Vol. 106 Issue 10, pe4155, 8 p.
Subject
Language
English
ISSN
0021-972X
Abstract
In patients with osteoporosis who are discontinuing denosumab (Dmab) therapy, an increase in bone turnover above pretreatment values, resulting in rapid decrease of bone mineral density (BMD), is typically observed [...]
Context: Zoledronate is used to prevent bone loss following denosumab discontinuation but its efficacy differs among studies. Objective: To test if the duration of denosumab treatment affects the efficacy of subsequent zoledronate infusion. Methods: This multicenter, prospective cohort study, conducted at 2 Greek and 1 Dutch bone centers, included 47 postmenopausal women (n = 47) who received a single zoledronate infusion 6 months after the last denosumab injection and then were followed for 1 year. Twenty-seven women received [less than or equal to] 6 denosumab injections ([less than or equal to] 6 Group) and 20 received > 6 denosumab injections (> 6 Group). The main outcome measure was changes in lumbar spine (LS) bone mineral density (BMD). Results: At 12 months LS-BMD values were maintained in the [less than or equal to] 6 Group (0.98 [+ or -] 0.10 to 0.99 [+ or -] 0.9 g/[cm.sup.2], P = 0.409) but decreased significantly in the > 6 Group (1.0 [+ or -] 0.11 to 0.93 [+ or -] 0.12 g/[cm.sup.2], P < 0.001). The percent change of LS-BMD of the [less than or equal to] 6 Group (+1.0%) was significantly different (P < 0.001) from the change of the > 6 Group (-7.0%). In the whole cohort, the duration of denosumab treatment was negatively correlated with the percentage change of LS-BMD (r = -0.669, P < 0.001) but not with the change of femoral neck (FN)-BMD. Bone turnover markers increased in all patients 6 months following zoledronate administration with no difference between the 2 groups. Conclusion: The duration of denosumab treatment significantly affects the efficacy of subsequent zoledronate infusion to maintain BMD gains. Frequent follow-up of patients treated with denosumab longer than 3 years is advisable as additional therapeutic interventions may be needed. Key Words: bone mineral density, bone turnover markers, denosumab, postmenopausal osteoporosis, zoledronate
Context: Zoledronate is used to prevent bone loss following denosumab discontinuation but its efficacy differs among studies. Objective: To test if the duration of denosumab treatment affects the efficacy of subsequent zoledronate infusion. Methods: This multicenter, prospective cohort study, conducted at 2 Greek and 1 Dutch bone centers, included 47 postmenopausal women (n = 47) who received a single zoledronate infusion 6 months after the last denosumab injection and then were followed for 1 year. Twenty-seven women received [less than or equal to] 6 denosumab injections ([less than or equal to] 6 Group) and 20 received > 6 denosumab injections (> 6 Group). The main outcome measure was changes in lumbar spine (LS) bone mineral density (BMD). Results: At 12 months LS-BMD values were maintained in the [less than or equal to] 6 Group (0.98 [+ or -] 0.10 to 0.99 [+ or -] 0.9 g/[cm.sup.2], P = 0.409) but decreased significantly in the > 6 Group (1.0 [+ or -] 0.11 to 0.93 [+ or -] 0.12 g/[cm.sup.2], P < 0.001). The percent change of LS-BMD of the [less than or equal to] 6 Group (+1.0%) was significantly different (P < 0.001) from the change of the > 6 Group (-7.0%). In the whole cohort, the duration of denosumab treatment was negatively correlated with the percentage change of LS-BMD (r = -0.669, P < 0.001) but not with the change of femoral neck (FN)-BMD. Bone turnover markers increased in all patients 6 months following zoledronate administration with no difference between the 2 groups. Conclusion: The duration of denosumab treatment significantly affects the efficacy of subsequent zoledronate infusion to maintain BMD gains. Frequent follow-up of patients treated with denosumab longer than 3 years is advisable as additional therapeutic interventions may be needed. Key Words: bone mineral density, bone turnover markers, denosumab, postmenopausal osteoporosis, zoledronate