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González Macías J, Olmos Martínez JM. Aminobisphosphonates: Reconsideration 25 years after their approval for the treatment of osteoporosis. Med Clin (Barc) 2022; 159:336-343. [PMID: 35738929 DOI: 10.1016/j.medcli.2022.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 04/18/2022] [Accepted: 04/21/2022] [Indexed: 11/15/2022]
Abstract
Aminobisphosphonates are widely used in the treatment of osteoporosis. They have a high affinity for hydroxyapatite, binding primarily to resorbing surfaces, but also to forming surfaces and to some extent to resting surfaces. They inhibit osteoclasts, thereby decreasing remodelling units. Consequently, they increase bone mass and reduce stress risers. This decreases the risk of fractures. If this decrease is sufficient, they can be temporarily withdrawn (drug holidays), which prevents serious complications (atypical femoral fracture). They probably reduce mortality. Virtually all patients with osteoporosis can benefit from them at some point in the course of their disease (at the beginning of treatment or after the administration of anabolics, selective estrogen receptor modulators or denosumab). If well tolerated orally, alendronate and risedronate are preferable. Otherwise, zoledronate is preferred. Their efficacy vs. cost-safety-convenience ratio makes aminobisphosphonates reference drugs in the field of osteoporosis.
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Affiliation(s)
- Jesús González Macías
- Departamento de Medicina y Psiquiatría, Universidad de Cantabria, Santander, Cantabria, España.
| | - José Manuel Olmos Martínez
- Departamento de Medicina y Psiquiatría, Universidad de Cantabria, Santander, Cantabria, España; Servicio de Medicina Interna, Hospital Marqués de Valdecilla, Santander, Cantabria, España
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3
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Wang M, Wu Y, Girgis CM. Bisphosphonate Drug Holidays: Evidence from Clinical Trials and
Real‐World
Studies. JBMR Plus 2022; 6:e10629. [PMID: 35720669 PMCID: PMC9189912 DOI: 10.1002/jbm4.10629] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Revised: 03/26/2022] [Accepted: 04/08/2022] [Indexed: 11/09/2022] Open
Affiliation(s)
- Mawson Wang
- Department of Diabetes and Endocrinology Westmead Hospital Westmead NSW Australia
- Faculty of Medicine and Health University of Sydney Sydney NSW Australia
| | - Yu‐Fang Wu
- Department of Diabetes and Endocrinology Westmead Hospital Westmead NSW Australia
| | - Christian M Girgis
- Department of Diabetes and Endocrinology Westmead Hospital Westmead NSW Australia
- Faculty of Medicine and Health University of Sydney Sydney NSW Australia
- Department of Endocrinology Royal North Shore Hospital St Leonards NSW Australia
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Hsu CS, Chang ST, Cheng YY, Lee HT, Chen CH, Deng YL, Hsu CY, Chen YM. Low Bone Mineral Density and Calcium Levels as Risks for Mortality in Patients with Self-Discontinuation of Anti-Osteoporosis Medication. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 19:197. [PMID: 35010457 PMCID: PMC8750269 DOI: 10.3390/ijerph19010197] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 12/15/2021] [Accepted: 12/22/2021] [Indexed: 06/14/2023]
Abstract
Bone mass density (BMD) has been used universally in osteoporosis diagnosis and management. Adherence to anti-osteoporosis medication is related to mortality risk. This study aimed to investigate the relationship between mortality and low BMD of the femoral neck and vertebra among patients self-discontinuing anti-osteoporosis medication. Between June 2016 and June 2018, this single-center retrospective study recruited 596 participants who self-discontinued anti-osteoporosis medication. Patients were categorized into four groups by BMD of the right femoral neck and lumbar spine. Occurrence and causes of mortality were obtained from medical records. Independent risk factors and the five-year survival of various levels of BMD were analyzed by Cox regression and the Kaplan-Meier survival analysis. BMD value and serum calcium level were significantly lower in the mortality group (p < 0.001). Compared to the reference, the adjusted hazard ratio (HR) for all-cause mortality in patients with lower BMD of both the lumbar spine and femoral neck was 3.03. The five-year cumulative survival rate was also significantly lower (25.2%, p < 0.001). A low calcium level was also associated with mortality (HR: 0.87, 95% CI: 0.76-0.99, p = 0.033). In conclusion, lower BMD and calcium levels were associated with higher mortality risk in patients with poor adherence. Hence, patients self-discontinuing anti-osteoporosis medication should be managed accordingly.
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Affiliation(s)
- Chun-Sheng Hsu
- Department of Physical Medicine and Rehabilitation, Taichung Veterans General Hospital, Taichung 40705, Taiwan; (C.-S.H.); (S.-T.C.); (Y.-Y.C.)
- College of Medicine, National Chung Hsing University, Taichung 402202, Taiwan;
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei 11490, Taiwan
| | - Shin-Tsu Chang
- Department of Physical Medicine and Rehabilitation, Taichung Veterans General Hospital, Taichung 40705, Taiwan; (C.-S.H.); (S.-T.C.); (Y.-Y.C.)
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei 11490, Taiwan
- Department of Physical Medicine and Rehabilitation, Kaohsiung Veterans General Hospital, Kaohsiung 813414, Taiwan
| | - Yuan-Yang Cheng
- Department of Physical Medicine and Rehabilitation, Taichung Veterans General Hospital, Taichung 40705, Taiwan; (C.-S.H.); (S.-T.C.); (Y.-Y.C.)
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan;
| | - Hsu-Tung Lee
- College of Medicine, National Chung Hsing University, Taichung 402202, Taiwan;
- Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei 11490, Taiwan
- Cancer Prevention and Control Center, Taichung Veterans General Hospital, Taichung 40705, Taiwan
- Department of Neurosurgery, Neurological Institute, Taichung Veterans General Hospital, Taichung 40705, Taiwan
| | - Chih-Hui Chen
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan;
- Department of Orthopedics, Taichung Veterans General Hospital, Taichung 40705, Taiwan
| | - Ya-Lian Deng
- Department of Nursing, Taichung Veterans General Hospital, Taichung 40705, Taiwan;
| | - Chiann-Yi Hsu
- Department of Medical Research, Taichung Veterans General Hospital, Taichung 40705, Taiwan;
| | - Yi-Ming Chen
- College of Medicine, National Chung Hsing University, Taichung 402202, Taiwan;
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan;
- Department of Medical Research, Taichung Veterans General Hospital, Taichung 40705, Taiwan;
- Division of Allergy, Immunology and Rheumatology, Taichung Veterans General Hospital, Taichung 40705, Taiwan
- Rong Hsing Research Center for Translational Medicine, National Chung Hsing University, Taichung 402202, Taiwan
- Ph.D. Program in Translational Medicine, National Chung Hsing University, Taichung 402202, Taiwan
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Bauer DC, Abrahamsen B. Bisphosphonate Drug Holidays in Primary Care: When and What to Do Next? Curr Osteoporos Rep 2021; 19:182-188. [PMID: 33528743 PMCID: PMC8744486 DOI: 10.1007/s11914-021-00660-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/19/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW This review describes the rational for bisphosphonate holidays, summaries key evidence to support the concept, and provides a roadmap to help clinicians initiate, monitor, and discontinue a bisphosphonate drug holiday. RECENT FINDINGS Randomized trials and data from large observational studies are available to determine the short and long-term bisphosphonate benefits (prevention of fracture) and harms (principally atypical femoral fractures and osteonecrosis of the jaw). Mounting evidence points towards a causal relationship between bisphosphonate use and AFF and ONJ, particularly with > 5 years of use. Multiple studies now confirm the risk of AFF falls rapidly after BPs are discontinued. Osteoporosis patients without previous hip, vertebral, or multiple non-spine fractures who are successfully treated with oral bisphosphonates for 5 years (3 years if intravenous), should be offered a 3-5 year drug holiday, particularly if hip BMD T-score is > - 2.5. Bisphosphonates should only be continued beyond 10 years (6 years if parenteral) in patients at very high risk of fracture.
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Affiliation(s)
- Douglas C Bauer
- University of California, San Francisco, 1545 Divisadero, 3rd floor, San Francisco, CA, 94143, USA.
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