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Osteologie 2023; 32(02): 115-122
DOI: 10.1055/a-2034-6086
Leitlinie

Recommendations for the Pharmacological Treatment of Osteoporosis – Update 2023 of the German Osteoporosis Guideline

Empfehlungen zur spezifischen medikamentösen Therapie der Osteoporose – Update 2023 der DVO-Leitlinie
Ralf Schmidmaier
1   Department of Medicine IV, University Hospital, LMU Munich, Munich, Germany
,
Peyman Hadji
2   Frankfurt Center for Bone Health and Endocrinology and Philipps-Universität Marburg, Marburg, Germany
,
Peter Kern
3   Department for Internal Medicine IV (Immunology, Rheumatology and Osteology), University Medicine Marburg – Campus Fulda, University of Marburg, Marburg, Germany
,
Michael Drey
4   Department of Medicine IV, Geriatrics, University Hospital, LMU Munich, Munich, Germany
,
Franz Jakob
5   Bernhard-Heine-Centrum für Bewegungsforschung, Julius-Maximilians-Universität Würzburg, Wurzburg, Germany
,
Friederike Thomasius
6   Frankfurt Center for Bone Health and Endocrinology, Frankfurt, Germany
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Abstract

Aim The German osteoporosis guideline was updated on the basis of a systematic literature review and through a structured consensus process by an interdisciplinary, international (Germany, Austria, Switzerland) expert group representing the 20 member societies of the Joint Osteological Association (DVO) and patient advocacy organizations (BfO). This manuscript summarizes the changes in the German osteoporosis guideline with regard to pharmacological interventions and offers pragmatic pathways for implementation.

Method Systematic literature search and structured consensus building according to AWMF regulations.

Results The sclerostin antibody romosozumab was adopted into the guideline. In addition, the effectiveness of teriparatide was re-evaluated. For both bone anabolic agents evidence from randomized trials underlined a superiority over oral bisphosphonates with regard to fracture risk reduction. Between the antiresorptive treatments, differences regarding superiority/inferiority could only be shown with respect to surrogate parameters, not with regard to fractures. Data about the duration of treatment of all available drugs is limited. All non-bisphosphonate treatments require follow-up treatment.

Conclusion An individualized treatment concept should be developed in a shared decision process, including a bone anabolic-first strategy in high-risk patients. Recommendations on treatment duration, drug holidays and sequential strategies should be considered.

Zusammenfassung

Ziel Auf Basis eines systematischen Literaturreviews und durch strukturierte Konsensfindung einer interdisziplinären, internationalen (Deutschland, Österreich, Schweiz) Expertengruppe, welche die 20 Mitgliedgesellschaften des Dachverbandes Osteologie (DVO) und die Patientenvertretung Bundesselbsthilfeverband für Osteoporose e.V. (BfO) repräsentiert, wurde die deutschsprachige S3-Osteoporoseleitlinie aktualisiert. In diesem Artikel werden die Neuerungen des Kapitels zur medikamentösen Therapie vorgestellt und Möglichkeiten zum Transfer in die tägliche Praxis diskutiert.

Methode Systematische Literaturrecherche und strukturierte Konsensfindung gemäß AWMF-Regelwerk.

Ergebnisse Neu aufgenommen wurde in die Leitlinie der Sklerostin Antikörper Romosozumab. Zudem erfolgte eine Neubewertung der Effektivität von Teriparatid. Für beide Osteoanabolika liegt Evidenz aus randomisierten, direkten Vergleichsstudien vor, die eine Überlegenheit gegenüber oralen Bisphosphonaten bezüglich Frakturrisikoreduktion zeigen. Innerhalb der Antiresorptiva konnten nur Unterschiede der Überlegenheit/Unterlegenheit bezüglich Surrogatparametern, nicht bezüglich Frakturen gezeigt werden. Die Daten zur Therapiedauer aller verfügbarer Medikamente sind limitiert. Nicht-Bisphosphonate erfordern eine Anschlusstherapie.

Schlussfolgerung Es sollte partizipativ ein individuelles Therapiekonzept entwickelt werden; bei Hochrisikopatienten mit einer Osteoanabol-First-Strategie. Empfehlungen zur Therapiedauer, Therapiepausen und notwendigen Sequenzen sind zu beachten.

Key words

Osteoporosis - guideline - drugs - treatment

Schlüsselwörter

Osteoporose - Leitlinie - Medikamente - Therapie


Publication History

Received: 29 December 2022

Accepted: 11 February 2023

Article published online:
25 May 2023

© 2023. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Saag KG, Petersen J, Brandi ML. et al. Romosozumab or Alendronate for Fracture Prevention in Women with Osteoporosis. N Engl J Med 2017; 377: 1417-1427 DOI: 10.1056/NEJMoa1708322.. Epub 2017 Sep 11 PMID: 28892457
    CrossrefPubMedGoogle Scholar
  • 2 Davis S, Simpson E, Hamilton J. et al. Denosumab, raloxifene, romosozumab and teriparatide to prevent osteoporotic fragility fractures: a systematic review and economic evaluation. Health Technol Assess 2020; 24: 1-314 DOI: 10.3310/hta24290.. PMID: 32588816; PMCID: PMC7357239
    CrossrefPubMedGoogle Scholar
  • 3 Díez-Pérez A, Marin F, Eriksen EF. et al. Effects of teriparatide on hip and upper limb fractures in patients with osteoporosis: A systematic review and meta-analysis. Bone 2019; 120: 1-8 DOI: 10.1016/j.bone.2018.09.020.. Epub 2018 Sep 27 PMID: 30268814
    CrossrefPubMedGoogle Scholar
  • 4 Simpson EL, Martyn-St James M, Hamilton J. et al. Clinical effectiveness of denosumab, raloxifene, romosozumab, and teriparatide for the prevention of osteoporotic fragility fractures: A systematic review and network meta-analysis. Bone 2020; 130: 115081 DOI: 10.1016/j.bone.2019.115081.. Epub 2019 Oct 15 PMID: 31626995
    CrossrefPubMedGoogle Scholar
  • 5 Cummings SR, Cosman F, Lewiecki EM. et al. Goal-Directed Treatment for Osteoporosis: A Progress Report From the ASBMR-NOF Working Group on Goal-Directed Treatment for Osteoporosis. J Bone Miner Res 2017; 32: 3-10 DOI: 10.1002/jbmr.3039.. Epub 2016 Dec 27 PMID: 27864889
    CrossrefPubMedGoogle Scholar
  • 6 Thomas T, Casado E, Geusens P. et al. Is a treat-to-target strategy in osteoporosis applicable in clinical practice? Consensus among a panel of European experts. Osteoporos Int 2020; 31: 2303-2311 DOI: 10.1007/s00198-020-05569-9.. Epub 2020 Aug 7 PMID: 32767094; PMCID: PMC7661407
    CrossrefPubMedGoogle Scholar
  • 7 Austrian Breast and Colorectal Cancer Study Group. Gnant M, Pfeiler G, Dubsky PC. et al. Adjuvant denosumab in breast cancer (ABCSG-18): a multicentre, randomised, double-blind, placebo-controlled trial. Lancet 2015; 386: 433-443 DOI: 10.1016/S0140-6736(15)60995-3.. Epub 2015 May 31 PMID: 26040499
    CrossrefPubMedGoogle Scholar
  • 8 Reid IR, Horne AM, Mihov B. et al. Anti-fracture efficacy of zoledronate in subgroups of osteopenic postmenopausal women: secondary analysis of a randomized controlled trial. J Intern Med 2019; 286: 221-229 DOI: 10.1111/joim.12901.. Epub 2019 Apr 8 PMID: 30887607
    CrossrefPubMedGoogle Scholar
  • 9 Denosumab HALT Prostate Cancer Study Group. Smith MR, Egerdie B, Hernández Toriz N. et al. Denosumab in men receiving androgen-deprivation therapy for prostate cancer. N Engl J Med 2009; 361: 745-755 DOI: 10.1056/NEJMoa0809003.. Epub 2009 Aug 11 PMID: 19671656; PMCID: PMC3038121
    CrossrefPubMedGoogle Scholar
  • 10 Kendler DL, Marin F, Zerbini CAF. et al. Effects of teriparatide and risedronate on new fractures in post-menopausal women with severe osteoporosis (VERO): a multicentre, double-blind, double-dummy, randomised controlled trial. Lancet 2018; 391: 230-240 DOI: 10.1016/S0140-6736(17)32137-2. Epub 2017 Nov 9. Erratum in: Lancet. 2017 Nov 30;: Erratum in: Lancet. 2018 Dec 1;392(10162):2352PMID: 29129436
    CrossrefPubMedGoogle Scholar
  • 11 Fontalis A, Kenanidis E, Prousali E. et al. Safety and efficacy of denosumab in osteoporotic patients previously treated with other medications: a systematic review and meta-analysis. Expert Opin Drug Saf 2018; 17: 413-428 DOI: 10.1080/14740338.2018.1430764.. Epub 2018 Jan 25 PMID: 29350565
    CrossrefPubMedGoogle Scholar
  • 12 Lyu H, Jundi B, Xu C. et al. Comparison of Denosumab and Bisphosphonates in Patients With Osteoporosis: A Meta-Analysis of Randomized Controlled Trials. J Clin Endocrinol Metab 2019; 104: 1753-1765 DOI: 10.1210/jc.2018-02236.PMID: 30535289; PMCID: PMC644795.
    CrossrefPubMedGoogle Scholar
  • 13 Leder BZ, Tsai JN, Uihlein AV. et al. Two years of Denosumab and teriparatide administration in postmenopausal women with osteoporosis (The DATA Extension Study): a randomized controlled trial. J Clin Endocrinol Metab 2014; 99: 1694-1700 DOI: 10.1210/jc.2013-4440.. Epub 2014 Feb 11 PMID: 24517156; PMCID: PMC4010689
    CrossrefPubMedGoogle Scholar
  • 14 Tsai JN, Uihlein AV, Lee H. et al. Teriparatide and denosumab, alone or combined, in women with postmenopausal osteoporosis: the DATA study randomised trial. Lancet 2013; 382: 50-56 DOI: 10.1016/S0140-6736(13)60856-9.. Epub 2013 May 15 PMID: 23683600; PMCID: PMC4083737
    CrossrefPubMedGoogle Scholar
  • 15 Cosman F, Eriksen EF, Recknor C. et al. Effects of intravenous zoledronic acid plus subcutaneous teriparatide [rhPTH(1-34)] in postmenopausal osteoporosis. J Bone Miner Res 2011; 26: 503-511 DOI: 10.1002/jbmr.238.PMID: 20814967.
    CrossrefGoogle Scholar
  • 16 Cornelissen D, de Kunder S, Si L. et al. European Society for Clinical and Economic Aspect of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO). Interventions to improve adherence to anti-osteoporosis medications: an updated systematic review. Osteoporos Int 2020; 31: 1645-1669 DOI: 10.1007/s00198-020-05378-0.. Epub 2020 May 1 PMID: 32358684; PMCID: PMC7423788
    CrossrefPubMedGoogle Scholar
  • 17 Hiligsmann M, Salas M, Hughes DA. et al. Interventions to improve osteoporosis medication adherence and persistence: a systematic review and literature appraisal by the ISPOR Medication Adherence & Persistence Special Interest Group. Osteoporos Int 2013; 24: 2907-2918 DOI: 10.1007/s00198-013-2364-z.. Epub 2013 May 1 PMID: 23636230
    CrossrefPubMedGoogle Scholar
  • 18 Hadji P, Felsenberg D, Amling M. et al. The non-interventional BonViva Intravenous Versus Alendronate (VIVA) study: real-world adherence and persistence to medication, efficacy, and safety, in patients with postmenopausal osteoporosis. Osteoporos Int 2014; 25: 339-347 DOI: 10.1007/s00198-013-2515-2.. Epub 2013 Oct 3 PMID: 24091594
    CrossrefPubMedGoogle Scholar
  • 19 Hadji P, Papaioannou N, Gielen E. et al. Fahrleitner-Pammer A. Persistence, adherence, and medication-taking behavior in women with postmenopausal osteoporosis receiving denosumab in routine practice in Germany, Austria, Greece, and Belgium: 12-month results from a European non-interventional study. Osteoporos Int 2015; 26: 2479-2489 DOI: 10.1007/s00198-015-3164-4.. Epub 2015 May 28 PMID: 26018090; PMCID: PMC4575374
    CrossrefPubMedGoogle Scholar
  • 20 Karlsson L, Lundkvist J, Psachoulia E. et al. Persistence with denosumab and persistence with oral bisphosphonates for the treatment of postmenopausal osteoporosis: a retrospective, observational study, and a meta-analysis. Osteoporos Int 2015; 26: 2401-2411 DOI: 10.1007/s00198-015-3253-4.. Epub 2015 Aug 18 PMID: 26282229; PMCID: PMC4575381
    CrossrefPubMedGoogle Scholar
  • 21 Roh YH, Noh JH, Gong HS. et al. Comparative adherence to weekly oral and quarterly intravenous bisphosphonates among patients with limited heath literacy who sustained distal radius fractures. J Bone Miner Metab 2018; 36: 589-595 DOI: 10.1007/s00774-017-0867-y.. Epub 2017 Oct 5
    CrossrefPubMedGoogle Scholar
  • 22 Ettinger B, Black DM, Mitlak BH. et al. Reduction of vertebral fracture risk in postmenopausal women with osteoporosis treated with raloxifene: results from a 3-year randomized clinical trial. Multiple Outcomes of Raloxifene Evaluation (MORE) Investigators. JAMA 1999; 282: 637-645 DOI: 10.1001/jama.282.7.637. Erratum in: JAMA 1999 Dec 8;282(22):2124 PMID: 10517716
    CrossrefPubMedGoogle Scholar
  • 23 Delmas PD, Ensrud KE, Adachi JD. et al. Mulitple Outcomes of Raloxifene Evaluation Investigators. Efficacy of raloxifene on vertebral fracture risk reduction in postmenopausal women with osteoporosis: four-year results from a randomized clinical trial. J Clin Endocrinol Metab 2002; 87: 3609-3617 DOI: 10.1210/jcem.87.8.8750. PMID: 12161484.
    CrossrefGoogle Scholar
  • 24 Martino S, Disch D, Dowsett SA. et al. Safety assessment of raloxifene over eight years in a clinical trial setting. Curr Med Res Opin 2005; 21: 1441-1452 DOI: 10.1185/030079905X61839.. PMID: 16197663
    CrossrefPubMedGoogle Scholar
  • 25 Siris ES, Harris ST, Eastell R. et al. Continuing Outcomes Relevant to Evista (CORE) Investigators. Skeletal effects of raloxifene after 8 years: results from the continuing outcomes relevant to Evista (CORE) study. J Bone Miner Res 2005; 20: 1514-1524 DOI: 10.1359/JBMR.050509.. Epub 2005 May 16 PMID: 16059623
    CrossrefPubMedGoogle Scholar
  • 26 Liberman UA, Weiss SR, Bröll J. et al. Effect of oral alendronate on bone mineral density and the incidence of fractures in postmenopausal osteoporosis. The Alendronate Phase III Osteoporosis Treatment Study Group. N Engl J Med 1995; 333: 1437-1443 DOI: 10.1056/NEJM199511303332201.. PMID: 7477143
    CrossrefPubMedGoogle Scholar
  • 27 Black DM, Cummings SR, Karpf DB. et al. Randomised trial of effect of alendronate on risk of fracture in women with existing vertebral fractures. Fracture Intervention Trial Research Group. Lancet 1996; 348: 1535-1541 DOI: 10.1016/s0140-6736(96)07088-2.. PMID: 8950879
    CrossrefPubMedGoogle Scholar
  • 28 Alendronate Phase III Osteoporosis Treatment Study Group. Bone HG, Hosking D, Devogelaer JP. et al. Ten years’ experience with alendronate for osteoporosis in postmenopausal women. N Engl J Med 2004; 350: 1189-1199 DOI: 10.1056/NEJMoa030897.. PMID: 15028823
    CrossrefPubMedGoogle Scholar
  • 29 FLEX Research Group. Black DM, Schwartz AV, Ensrud KE. et al. Effects of continuing or stopping alendronate after 5 years of treatment: the Fracture Intervention Trial Long-term Extension (FLEX): a randomized trial. JAMA 2006; 296: 2927-2938 DOI: 10.1001/jama.296.24.2927.. PMID: 17190893
    CrossrefPubMedGoogle Scholar
  • 30 FLEX Research Group. Schwartz AV, Bauer DC, Cummings SR. et al. Efficacy of continued alendronate for fractures in women with and without prevalent vertebral fracture: the FLEX trial. J Bone Miner Res 2010; 25: 976-982 DOI: 10.1002/jbmr.11.. PMID: 20200926
    CrossrefPubMedGoogle Scholar
  • 31 Harris ST, Watts NB, Genant HK. et al. Effects of risedronate treatment on vertebral and nonvertebral fractures in women with postmenopausal osteoporosis: a randomized controlled trial. Vertebral Efficacy With Risedronate Therapy (VERT) Study Group. JAMA. 1999; 282: 1344-1352 DOI: 10.1001/jama.282.14.1344.. PMID: 10527181
    CrossrefPubMedGoogle Scholar
  • 32 Reginster J, Minne HW, Sorensen OH. et al. Randomized trial of the effects of risedronate on vertebral fractures in women with established postmenopausal osteoporosis. Vertebral Efficacy with Risedronate Therapy (VERT) Study Group. Osteoporos Int 2000; 11: 83-91 DOI: 10.1007/s001980050010.. PMID: 10663363
    CrossrefPubMedGoogle Scholar
  • 33 Sorensen OH, Crawford GM, Mulder H. et al. Long-term efficacy of risedronate: a 5-year placebo-controlled clinical experience. Bone. 2003; 32: 120-126 DOI: 10.1016/s8756-3282(02)00946-8.. PMID: 12633783
    CrossrefPubMedGoogle Scholar
  • 34 Mellström DD, Sörensen OH, Goemaere S. et al. Seven years of treatment with risedronate in women with postmenopausal osteoporosis. Calcif Tissue Int 2004; 75: 462-468 DOI: 10.1007/s00223-004-0286-7.. Epub 2004 Oct 7 PMID: 15455188
    CrossrefPubMedGoogle Scholar
  • 35 Chesnut CH, Skag A, Christiansen C. et al. Oral Ibandronate Osteoporosis Vertebral Fracture Trial in North America and Europe (BONE). Effects of oral ibandronate administered daily or intermittently on fracture risk in postmenopausal osteoporosis. J Bone Miner Res 2004; 19: 1241-1249 DOI: 10.1359/JBMR.040325.. Epub 2004 Mar 29 PMID: 15231010
    CrossrefPubMedGoogle Scholar
  • 36 Miller PD, Recker RR, Reginster JY. et al. Efficacy of monthly oral ibandronate is sustained over 5 years: the MOBILE long-term extension study. Osteoporos Int 2012; 23: 1747-1756 DOI: 10.1007/s00198-011-1773-0.. Epub 2011 Sep 28 PMID: 21953471
    CrossrefPubMedGoogle Scholar
  • 37 Black DM, Delmas PD, Eastell R. et al. HORIZON Pivotal Fracture Trial. Once-yearly zoledronic acid for treatment of postmenopausal osteoporosis. N Engl J Med 2007; 356: 1809-1822 DOI: 10.1056/NEJMoa067312.. PMID: 17476007
    CrossrefPubMedGoogle Scholar
  • 38 Black DM, Reid IR, Boonen S. et al. The effect of 3 versus 6 years of zoledronic acid treatment of osteoporosis: a randomized extension to the HORIZON-Pivotal Fracture Trial (PFT). J Bone Miner Res 2012; 27: 243-254 DOI: 10.1002/jbmr.1494. Erratum in: J Bone Miner Res. 2012 Dec;27(12):2612 PMID: 22161728; PMCID: PMC3427916
    CrossrefPubMedGoogle Scholar
  • 39 Eisman JA, Civitelli R, Adami S. et al. Efficacy and tolerability of intravenous ibandronate injections in postmenopausal osteoporosis: 2-year results from the DIVA study. J Rheumatol 2008; 35: 488-497 Epub 2008 Feb 1 PMID: 18260172
    Google Scholar
  • 40 Bianchi G, Czerwinski E, Kenwright A. et al. Long-term administration of quarterly IV ibandronate is effective and well tolerated in postmenopausal osteoporosis: 5-year data from the DIVA study long-term extension. Osteoporos Int 2012; 23: 1769-1778 DOI: 10.1007/s00198-011-1793-9.. PMID: 21975558
    CrossrefPubMedGoogle Scholar
  • 41 Cummings SR, San Martin J, McClung MR. et al. FREEDOM Trial. Denosumab for prevention of fractures in postmenopausal women with osteoporosis. N Engl J Med 2009; 361: 756-765 DOI: 10.1056/NEJMoa0809493. Epub 2009 Aug 11. Erratum in: N Engl J Med. 2009 Nov 5;361(19):1914 PMID: 19671655
    CrossrefPubMedGoogle Scholar
  • 42 Bone HG, Chapurlat R, Brandi ML. et al. The effect of three or six years of denosumab exposure in women with postmenopausal osteoporosis: results from the FREEDOM extension. J Clin Endocrinol Metab 2013; 98: 4483-4492 DOI: 10.1210/jc.2013-1597.. Epub 2013 Aug 26 PMID: 23979955; PMCID: PMC4207950
    CrossrefPubMedGoogle Scholar
  • 43 Bone HG, Wagman RB, Brandi ML. et al. 10 years of denosumab treatment in postmenopausal women with osteoporosis: results from the phase 3 randomised FREEDOM trial and open-label extension. Lancet Diabetes Endocrinol 2017; 5: 513-523 DOI: 10.1016/S2213-8587(17)30138-9.. Epub 2017 May 22 PMID: 28546097
    CrossrefPubMedGoogle Scholar
  • 44 Cosman F, Crittenden DB, Adachi JD. et al. Romosozumab Treatment in Postmenopausal Women with Osteoporosis. N Engl J Med 2016; 375: 1532-1543 DOI: 10.1056/NEJMoa1607948.. Epub 2016 Sep 18 PMID: 27641143
    CrossrefPubMedGoogle Scholar
  • 45 Neer RM, Arnaud CD, Zanchetta JR. et al. Effect of parathyroid hormone (1-34) on fractures and bone mineral density in postmenopausal women with osteoporosis. N Engl J Med 2001; 344: 1434-1441 DOI: 10.1056/NEJM200105103441904.. PMID: 11346808
    CrossrefPubMedGoogle Scholar
  • 46 Bone HG, Bolognese MA, Yuen CK. et al. Effects of denosumab treatment and discontinuation on bone mineral density and bone turnover markers in postmenopausal women with low bone mass. J Clin Endocrinol Metab 2011; 96: 972-980 DOI: 10.1210/jc.2010-1502.. Epub 2011 Feb 2 PMID: 21289258
    CrossrefPubMedGoogle Scholar
  • 47 Lindsay R, Scheele WH, Neer R. et al. Sustained vertebral fracture risk reduction after withdrawal of teriparatide in postmenopausal women with osteoporosis. Arch Intern Med 2004; 164: 2024-2030 DOI: 10.1001/archinte.164.18.2024.. PMID: 15477438
    CrossrefPubMedGoogle Scholar
  • 48 McClung MR, Brown JP, Diez-Perez A. et al. Effects of 24 Months of Treatment With Romosozumab Followed by 12 Months of Denosumab or Placebo in Postmenopausal Women With Low Bone Mineral Density: A Randomized, Double-Blind, Phase 2, Parallel Group Study. J Bone Miner Res 2018; 33: 1397-1406 DOI: 10.1002/jbmr.3452.. Epub 2018 May 22 PMID: 29694685
    CrossrefPubMedGoogle Scholar
  • 49 Cummings SR, Ferrari S, Eastell R. et al. Vertebral Fractures After Discontinuation of Denosumab: A Post Hoc Analysis of the Randomized Placebo-Controlled FREEDOM Trial and Its Extension. J Bone Miner Res 2018; 33: 190-198 DOI: 10.1002/jbmr.3337.. Epub 2017 Nov 22 PMID: 29105841
    CrossrefPubMedGoogle Scholar
  • 50 Cosman F, Huang S, McDermott M. et al. Multiple Vertebral Fractures After Denosumab Discontinuation: FREEDOM and FREEDOM Extension Trials Additional Post Hoc Analyses. J Bone Miner Res 2022; 37: 2112-2120 DOI: 10.1002/jbmr.4705.. Epub 2022 Oct 12 PMID: 36088628
    CrossrefPubMedGoogle Scholar
  • 51 The Swiss Denosumab Study Group. Burckhardt P, Faouzi M, Buclin T. et al. Fractures After Denosumab Discontinuation: A Retrospective Study of 797 Cases. J Bone Miner Res 2021; 36: 1717-1728 DOI: 10.1002/jbmr.4335.. Epub 2021 May 19 PMID: 34009703; PMCID: PMC8518625
    CrossrefPubMedGoogle Scholar
  • 52 Tsourdi E, Langdahl B, Cohen-Solal M. et al. Discontinuation of Denosumab therapy for osteoporosis: A systematic review and position statement by ECTS. Bone 2017; 105: 11-17 DOI: 10.1016/j.bone.2017.08.003.. Epub 2017 Aug 5 PMID: 28789921
    Google Scholar
  • 53 Tsourdi E, Zillikens MC, Meier C. et al. Fracture risk and management of discontinuation of denosumab therapy: a systematic review and position statement by ECTS. J Clin Endocrinol Metab 2020; dgaa756 DOI: 10.1210/clinem/dgaa756.. Epub ahead of print PMID: 33103722
    CrossrefPubMedGoogle Scholar
  • 54 LeBoff MS, Greenspan SL, Insogna KL. et al. The clinician’s guide to prevention and treatment of osteoporosis. Osteoporos Int 2022; 33: 2049-2102 DOI: 10.1007/s00198-021-05900-y.. Epub 2022 Apr 28. Erratum in: Osteoporos Int. 2022 Jul 28 PMID: 35478046; PMCID: PMC9546973
    CrossrefPubMedGoogle Scholar
  • 55 Pineda-Moncusí M, El-Hussein L, Delmestri A. et al. Estimating the Incidence and Key Risk Factors of Cardiovascular Disease in Patients at High Risk of Imminent Fracture Using Routinely Collected Real-World Data From the UK. J Bone Miner Res 2022; 37: 1986-1996 DOI: 10.1002/jbmr.4648.. Epub 2022 Sep 8 PMID: 35818312
    CrossrefPubMedGoogle Scholar
  • 56 Sennerby U, Melhus H, Gedeborg R. et al. Cardiovascular diseases and risk of hip fracture. JAMA. 2009; 302: 1666-1673 DOI: 10.1001/jama.2009.1463.. PMID: 19843901
    CrossrefPubMedGoogle Scholar
  • 57 Seeto AH, Tadrous M, Gebre AK. et al. Evidence for the cardiovascular effects of osteoporosis treatments in randomized trials of post-menopausal women: A systematic review and Bayesian network meta-analysis. Bone 2022; 167: 116610 DOI: 10.1016/j.bone.2022.116610.. Epub ahead of print PMID: 36372197
    CrossrefPubMedGoogle Scholar
  • 58 Rodríguez AJ, Ernst MT, Nybo M. et al. Oral Bisphosphonate use Reduces Cardiovascular Events in a Cohort of Danish Patients Referred for Bone Mineral Density. J Clin Endocrinol Metab 2020; 105: dgaa481 DOI: 10.1210/clinem/dgaa481.. PMID: 32717068
    CrossrefPubMedGoogle Scholar