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Horm Metab Res 2021; 53(03): 185-190
DOI: 10.1055/a-1368-4218
Endocrine Care

Long-Term Follow-Up of Denosumab Discontinuers with Multiple Vertebral Fractures in the Real-World: A Case Series

Liana Tripto-Shkolnik 
1   Division of Endocrinology, Diabetes and Metabolism, Chaim Sheba Medical Center at Tel Hashomer, Ramat Gan, Israel
2   Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
,
Yair Liel
3   Ben-Gurion University of the Negev, Beer-Sheva, Israel
,
Naama Yekutiel
4   Maccabitech Institute of Research and Innovation, Maccabi Healthcare Services, Tel Aviv, Israel
,
Inbal Goldshtein
2   Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
4   Maccabitech Institute of Research and Innovation, Maccabi Healthcare Services, Tel Aviv, Israel
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Abstract

Denosumab discontinuation is associated with rapid reversal of bone turnover suppression and with a considerable increase in fracture risk, including a risk for multiple vertebral fractures (MVF). Long-term follow-up of patients who sustained MVF after denosumab discontinuation has not been reported. This case-series was aimed to provide a long-term follow-up on the management and outcome of denosumab discontinuers who initially presented with multiple vertebral fractures. Denosumab discontinuers were identified from a computerized database of a large healthcare provider. Baseline and follow-up clinical, laboratory, and imaging data were obtained from the computerized database and electronic medical records. The post-denosumab discontinuers MVF patients consisted of 12 women aged 71±12. Osteoporotic fractures were prevalent before denosumab discontinuation in 6 of the patients. The majority received bisphosphonates before denosumab. MVF occurred 134±76 days after denosumab discontinuation. The patients were followed for a median of 36.5 (IQR 28.2, 42.5) months after MVF. Two patients passed-away. Two patients suffered recurrent vertebral fractures. Following MVF, patients were treated inconsistently with denosumab, teriparatide, oral, and intravenous bisphosphonates, in various sequences. Two patients underwent vertebroplasty/kyphoplasty. This long-term follow-up of real-world patients with MVF following denosumab discontinuation reveals that management is inconsistent, and recurrent fractures are not uncommon. It calls for clear management guidelines for patients with MVF after denosumab discontinuation and for special attention to this high-risk group.

Key words

osteoporosis - vertebral fractures - treatment discontinuation - denosumab discontinuation


Publication History

Received: 19 September 2020

Accepted: 12 January 2021

Article published online:
15 February 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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