Abstract
Summary
Evidence on the management of rebound-associated vertebral fractures after denosumab discontinuation is scarce. This study describes seven patients retreated with denosumab, teriparatide or zoledronate for 24 months. Their bone mineral density remained stable or improved and no new fractures occurred suggesting that all three options might be adequate for their treatment.
Purpose
To describe the densitometric and biochemical changes achieved with osteoactive treatment after 24 months of follow-up in patients who suffered rebound-associated vertebral fractures (RAVFs) after Dmab discontinuation, and to report the occurrence of new vertebral and non-vertebral fractures.
Methods
Patients with RAVFs who received retreatment (RT) for 24 months were included. Bone mineral density (BMD) was assessed by dual-energy x-ray absorptiometry at the lumbar spine (LS), femoral neck (FN) and total hip (TH), along with C-terminal cross-linked telopeptide of type I collagen, osteocalcin, and bone alkaline phosphatase. Data were collected at the start of the RT and after 24 months.
Results
Seven female patients were included. RT consisted in Dmab (n = 3), teriparatide (TPT) (n = 3) and zoledronate (Zol) (n = 1). At 24 months, the mean BMD change was 2.2% at LS, 6.8% at FN and 3.8% at TH in the Dmab group, 7.5% at LS, 1.4% at FN and 3.7% at TH in the TPT group and, 5.0% at LS, 0.6% at FN and 3.9% at TH in the patient with Zol. After 24 months of follow-up, no patient suffered new fractures.
Conclusion
In this series of patients with RAVFs, we did not observe any new fractures and the BMD remained stable after 24 months of RT. Future studies are needed to evaluate the most suitable treatment approach after RAVFs but these preliminary data suggest that all denosumab, zoledronate and teriparatide might be adequate options.
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Data Availability
The data that support the findings of this study are available from the corresponding author, MBZ, upon reasonable request.
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We are sincerely grateful to Susana Carballo for proofreading the manuscript.
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Dolores Clifton Goldney, Carolina Pelegrin, Fernando Jerkovich, Vanesa Longobardi, Elena Gonzalez Rodriguez, and María Belén Zanchetta declare that they have no conflict of interest regarding this publication.
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Clifton Goldney, D., Pelegrin, C., Jerkovich, F. et al. Twenty-four months of follow-up in women with rebound-associated vertebral fractures after discontinuation of denosumab: a single-centre case series. Osteoporos Int 35, 165–171 (2024). https://doi.org/10.1007/s00198-023-06894-5
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DOI: https://doi.org/10.1007/s00198-023-06894-5