Study finds risk factors for vertebral fractures and bone loss after denosumab discontinuation

Key findings of the study were:

♦ Among 219 women, 171 received zoledronate after denosumab discontinuation, 26 had no subsequent treatment and 22 received other therapies (other BPs or a SERM).

♦Upon analysis, researchers found that zoledronate was associated with the fewest vertebral fractures (hazard ratio 0.16), and all subsequent therapies retained BMD at all sites to some extent.

♦ They also found that higher BMD loss was associated with younger age, lower BMI, longer denosumab treatment, lack of prior antiresorptive treatment and BMD gain under denosumab treatment.

♦ They noted that the BTM levels correlated with denosumab treatment duration and bone loss at the total hip but not the lumbar spine.

♦ These findings imply:

• Vertebral fractures after denosumab discontinuation were low with subsequent therapy.
• Pre-treatment with BPs, such as zoledronate, is associated with fewer vertebral fractures.
• Longer denosumab treatment was associated with increased bone loss afterwards.
• Higher BMD gains under treatment correlated with BMD loss upon discontinuation.

The authors concluded, "Compared to no subsequent therapy, zoledronate was associated with fewer vertebral fractures after denosumab. Further, BMD loss depended on denosumab treatment duration, age, prior BP therapy and BMD gain under denosumab therapy, whereas BTM levels were associated with bone loss at the total hip and denosumab treatment duration."

For further information:

https://doi.org/10.1016/j.bone.2020.115830