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Yahyavi SK, Holt R, Knudsen NK, Andreassen CH, Sejling C, Meddis A, Kjaer SK, Schwarz P, Jensen JEB, Torp-Pedersen C, Juul A, Selmer C, Blomberg Jensen M. Cancer risk in patients treated with denosumab compared with alendronate: A population-based cohort study. Bone 2024; 182:117053. [PMID: 38395247 DOI: 10.1016/j.bone.2024.117053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 01/17/2024] [Accepted: 02/19/2024] [Indexed: 02/25/2024]
Abstract
BACKGROUND Antiresorptive treatment is currently used in millions of patients with osteoporosis and cancer worldwide. Early studies of denosumab suggested a small signal in ovarian cancer incidence and emerging data suggest that denosumab stimulates germ cell proliferation in the gonads. This study aims to determine the association between the use of denosumab and the risk of reproductive cancers compared with the use of alendronate. RESEARCH DESIGN AND METHODS Using a cohort study design, we used the Danish nationwide registries to identify a population of subjects ≥50 years of age during 2010-2017 who started denosumab after being on alendronate treatment for at least six months. The cohort was matched 1:2 with patients who had been treated with alendronate alone for at least six months. The risk of reproductive cancers and the risk difference between groups were estimated using the Longitudinal Targeted Maximum Likelihood Estimation (L-TMLE) method. RESULTS We identified 6054 Danish individuals who underwent treatment with denosumab. These individuals were matched with 12,108 receiving alendronate. The absolute risk of reproductive cancer was 1.05 % (95 % CI 0.75-1.34) after three years for denosumab users and was not different 0.03 % (-0.34-0.39) than for alendronate users. In supplemental analyses, there was no increased risk of non-reproductive cancers associated with the use of denosumab (risk difference of 0.54 % (-0.41-1.19). Analysis comparing denosumab users with the general population gave similar results. CONCLUSION There was no difference in the risk of cancer following treatment with denosumab compared to treatment with alendronate assessed after a short follow-up of 3 years.
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Affiliation(s)
- Sam Kafai Yahyavi
- Division of Translational Endocrinology, Department of Endocrinology and Internal Medicine, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark; Group of Skeletal, Mineral, and Gonadal Endocrinology, Department of Growth and Reproduction, Rigshospitalet, University of Copenhagen, Denmark
| | - Rune Holt
- Division of Translational Endocrinology, Department of Endocrinology and Internal Medicine, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark; Group of Skeletal, Mineral, and Gonadal Endocrinology, Department of Growth and Reproduction, Rigshospitalet, University of Copenhagen, Denmark
| | - Nadia Krarup Knudsen
- Division of Translational Endocrinology, Department of Endocrinology and Internal Medicine, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark; Group of Skeletal, Mineral, and Gonadal Endocrinology, Department of Growth and Reproduction, Rigshospitalet, University of Copenhagen, Denmark
| | - Christine Hjorth Andreassen
- Division of Translational Endocrinology, Department of Endocrinology and Internal Medicine, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark; Group of Skeletal, Mineral, and Gonadal Endocrinology, Department of Growth and Reproduction, Rigshospitalet, University of Copenhagen, Denmark
| | - Christoffer Sejling
- Department of Public Health, Section of Biostatistics, University of Copenhagen, Copenhagen, Denmark
| | - Alessandra Meddis
- Department of Public Health, Section of Biostatistics, University of Copenhagen, Copenhagen, Denmark
| | - Susanne K Kjaer
- Department of Gynaecology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; Danish Cancer Institute, Unit of Virus, Lifestyle and Genes, Copenhagen, Denmark
| | - Peter Schwarz
- Department of Endocrinology and Metabolism, Rigshospitalet, University of Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Jens-Erik Beck Jensen
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Department of Endocrinology, Hvidovre Hospital, University of Copenhagen, Denmark
| | - Christian Torp-Pedersen
- Department of Cardiology, Nordsjaellands Hospital, Denmark; Department of Public Health, University of Copenhagen, Denmark
| | - Anders Juul
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Department of Growth and Reproduction, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; International Centre for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Christian Selmer
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Department of Endocrinology, Bispebjerg University Hospital, Copenhagen, Denmark.
| | - Martin Blomberg Jensen
- Division of Translational Endocrinology, Department of Endocrinology and Internal Medicine, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
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Kim JT, Kim YM, Jung KY, Choi H, Lee SY, Kim HJ. Efficacy and safety of denosumab treatment for Korean patients with Stage 3b-4 chronic kidney disease and osteoporosis. Korean J Intern Med 2024; 39:148-159. [PMID: 38145616 PMCID: PMC10790049 DOI: 10.3904/kjim.2023.292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 09/08/2023] [Accepted: 09/16/2023] [Indexed: 12/27/2023] Open
Abstract
BACKGROUND/AIMS We evaluated the efficacy and safety of denosumab treatment in severe chronic kidney disease (CKD) patients with osteoporosis. We also investigated whether the treatment affects the coronary artery calcifications. METHODS Twenty-seven postmenopausal women with Stage 3b-4 CKD and osteoporosis were enrolled. Twenty patients received denosumab plus calcium carbonate and vitamin D, and seven controls received calcium carbonate and vitamin D for 1 year. Dual-energy X-ray absorptiometry and coronary artery calcium (CAC) scoring computed tomography were performed before and after treatment. Hypocalcemic symptoms and serum calcium levels were evaluated. RESULTS After 1 year of treatment, the percent changes of femur neck (3.6 ± 3.2% vs. -0.7 ± 4.4%, p = 0.033) and total hip (3.4 ± 3.8% vs. -1.9 ± 2.1%, p = 0.001) bone mineral density (BMD) were significantly increased in the denosumab treated group compared to the control group. However, the percent change of lumbar spine BMD did not differ between two groups (5.6 ± 5.9% vs. 2.7 ± 3.9%, p = 0.273). The percent change of bone alkaline phosphatase was significantly different in the denosumab-treated group and control group (-31.1 ± 30.0% vs. 0.5 ± 32.0%, p = 0.027). CAC scores did not differ between groups. No hypocalcemic events occurred in both groups. CONCLUSION If carefully monitored and supplemented with calcium and vitamin D, denosumab treatment for 1 year provides significant benefits in patients with Stage 3b-4 CKD and osteoporosis. However, denosumab treatment did not affect coronary artery calcifications in these patients.
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Affiliation(s)
- Jin Taek Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Nowon Eulji University Hospital, Eulji University School of Medicine, Seoul,
Korea
| | - You Mi Kim
- Division of Nephrology, Department of Internal Medicine, Nowon Eulji University Hospital, Eulji University School of Medicine, Seoul,
Korea
| | - Kyong Yeun Jung
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Nowon Eulji University Hospital, Eulji University School of Medicine, Seoul,
Korea
| | - Hoonsung Choi
- Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul,
Korea
| | - So Young Lee
- Division of Nephrology, Department of Internal Medicine, Nowon Eulji University Hospital, Eulji University School of Medicine, Seoul,
Korea
| | - Hyo-Jeong Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Nowon Eulji University Hospital, Eulji University School of Medicine, Seoul,
Korea
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Hong N, Shin S, Lee S, Rhee Y. Romosozumab is associated with greater trabecular bone score improvement compared to denosumab in postmenopausal osteoporosis. Osteoporos Int 2023; 34:2059-2067. [PMID: 37596432 DOI: 10.1007/s00198-023-06889-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 08/11/2023] [Indexed: 08/20/2023]
Abstract
In this study, romosozumab demonstrated significantly greater improvement in trabecular bone score compared to denosumab therapy in postmenopausal women previously treated with antiresorptive agents. Notably, in patients previously treated with anti-resorptive agents, treatment with romosozumab resulted in similar increases in trabecular bone score compared to that of drug-naïve patients. PURPOSE Romosozumab significantly increases bone mineral density (BMD) and rapidly reduces fracture risk. Whether romosozumab can improve the spinal trabecular bone score (TBS) as a bone quality indicator merits further investigation. METHODS Data for postmenopausal women starting romosozumab or denosumab treatment at Severance Hospital, Korea, were analyzed. Romosozumab and denosumab groups were 1:1 matched using propensity scores, considering relevant covariates. Good responders were defined as those with TBS improvement of 5.8% or greater. RESULTS Overall, 174 patients (romosozumab, n = 87; denosumab, n = 87) were analyzed. Matched groups did not differ in age (64 years), weight, height, previous fracture (38%), lumbar spine or femoral neck BMD (T-score, -3.4 and -2.6, respectively), or prior bisphosphonate or selective estrogen receptor modulator (SERM) exposure (50%). The romosozumab group exhibited a greater increase in lumbar spine BMD (15.2% vs. 6.9%, p < 0.001) and TBS (3.7% vs. 1.7%, p = 0.013) than the denosumab group. In patients transitioning from bisphosphonate or SERM, romosozumab users showed greater improvement in TBS compared to denosumab users (3.9% versus 0.8%, P = 0.006); the drug-naive group showed no significant difference (3.6% versus 2.7%, P = 0.472). The romosozumab group had a higher proportion of good responders than the denosumab group (33.3% vs. 18.4%, p = 0.024). Romosozumab therapy for 12 months resulted in 3.8-fold higher odds of a good response in TBS than denosumab after covariate adjustment (adjusted odds ratio 3.85, p = 0.002). CONCLUSION Romosozumab could improve bone mass and bone quality, measured by TBS, in postmenopausal osteoporosis, particularly as a subsequent regimen in patients previously taking anti-resorptive agents.
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Affiliation(s)
- Namki Hong
- Division of Endocrinology, Department of Internal Medicine, Endocrine Research Institute, Yonsei University College of Medicine, Seoul, 03722, Republic of Korea
| | - Sungjae Shin
- Division of Endocrinology, Department of Internal Medicine, Endocrine Research Institute, Yonsei University College of Medicine, Seoul, 03722, Republic of Korea
- Division of Endocrinology, Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Goyang, 10444, Korea
| | - Seunghyun Lee
- Division of Endocrinology, Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, 26426, Republic of Korea
| | - Yumie Rhee
- Division of Endocrinology, Department of Internal Medicine, Endocrine Research Institute, Yonsei University College of Medicine, Seoul, 03722, Republic of Korea.
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Fernandes TL, Viezzer Fernandes B, Jitumori C, Franco GCN. A Case Report of Oral Bisphosphonate Treatment for Osteoporosis Leading to Atypical Femoral Fracture and Pathologic Mandibular Fracture. Am J Case Rep 2023; 24:e941144. [PMID: 37867315 PMCID: PMC10614430 DOI: 10.12659/ajcr.941144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 09/05/2023] [Accepted: 08/25/2023] [Indexed: 10/24/2023]
Abstract
BACKGROUND Bisphosphonates inhibit bone resorption in patients with postmenopausal osteoporosis and reduce osteoporotic fracture incidence. Medication-related osteonecrosis of the jaws (MRONJ) and atypical femoral fractures (AFF) are both rare but serious adverse effects of anti-resorptive drugs (ARD) such as bisphosphonates. The most advanced form of MRONJ is termed stage 3 and can lead to severe local sequelae like pathologic mandibular fractures (PMF). This study reports a case of MRONJ-related PMF and AFF with osteomyelitis secondary to bisphosphonate treatment for osteoporosis. CASE REPORT A 63-year-old white woman was diagnosed with PMF related to MRONJ stage 3 during treatment of an AFF with osteomyelitis. She had been treated for postmenopausal osteoporosis with 70 mg of alendronate weekly for 2 years. The PMF was treated by stable internal fixation combined with debridement and sequestrectomy, but further debridement was required and 2 mandibular implants were then removed. Postoperative recovery was uneventful and the mandibular infection was controlled after the second surgery. Three weeks later, she was discharged from the hospital, instructed to discontinue the use of alendronate, and referred for 30 sessions of hyperbaric oxygen therapy. At the 3-year follow-up, the PMF was completely healed without signs of mandibular infection or bone exposure. CONCLUSIONS This report raises awareness of both MRONJ and AFF as possible adverse effects of short-term bisphosphonate therapy for postmenopausal osteoporosis, and highlights the importance of dental and orthopedic follow-ups. It is crucial to emphasize the need for early diagnosis and treatment to prevent MRONJ progression to PMF.
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Affiliation(s)
- Tito Lúcio Fernandes
- Postgraduate Program in Dentistry, State University of Ponta Grossa (UEPG), Ponta Grossa, PR, Brazil
- Unimed General Hospital, Ponta Grossa, PR, Brazil
| | - Bruno Viezzer Fernandes
- Postgraduate Program in Dentistry, State University of Ponta Grossa (UEPG), Ponta Grossa, PR, Brazil
- Unimed General Hospital, Ponta Grossa, PR, Brazil
| | - Chigueyuki Jitumori
- Unimed General Hospital, Ponta Grossa, PR, Brazil
- School of Dentistry, Centro de Ensino Superior dos Campos Gerais (CESCAGE), Ponta Grossa, PR, Brazil
| | - Gilson Cesar Nobre Franco
- Postgraduate Program in Dentistry, State University of Ponta Grossa (UEPG), Ponta Grossa, PR, Brazil
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Mendes D, Penedones A, Alves C, Oliveira T, Donato A, Batel-Marques F. Ibandronate in the Prevention of Vertebral and Nonvertebral Osteoporotic Fractures: A Systematic Review of Experimental and Observational Studies. J Clin Rheumatol 2023; 29:78-83. [PMID: 36731043 DOI: 10.1097/rhu.0000000000001902] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND/OBJECTIVE This study aims to evaluate ibandronate clinical effectiveness in the prevention of osteoporosis-related vertebral fractures (VFs) and nonvertebral fractures (NVFs) in the treatment of postmenopausal osteoporosis. METHODS This systematic review was conducted in accordance with the Centre for Reviews and Dissemination's guidance and reporting in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement 2020. A literature search was performed in PubMed and EMBASE since their inception until February 7, 2022. Randomized controlled trials (RCTs), meta-analysis, experimental, and observational studies evaluating adult patients treated with ibandronate and assessed to osteoporotic fractures prevention were included. The risk of bias was assessed according to study design. Data were analyzed using descriptive statistics. RESULTS Eight references from 4 RCTs, 7 meta-analyses, and 6 observational studies were included. In RCTs, oral ibandronate was superior to placebo in the prevention of VF. However, the doses were lower than those approved. The meta-analyses confirmed these results and showed that adequate doses of oral ibandronate reduce the risk of NVF compared with insufficient doses. In observational studies, oral ibandronate (in approved doses) reduced the risk of VF compared with no treatment or risedronate or alendronate and the risk of NVF versus risedronate or alendronate; the risk of hip fractures was similar between ibandronate and other oral bisphosphonates. CONCLUSIONS There is strong evidence that ibandronate reduces the risk of VF in postmenopausal osteoporosis. The available evidence further suggests that ibandronate may reduce the risk of NVF versus insufficient doses of ibandronate, as well as risedronate or alendronate.
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Tutaworn T, Nieves JW, Wang Z, Levin JE, Yoo JE, Lane JM. Bone loss after denosumab discontinuation is prevented by alendronate and zoledronic acid but not risedronate: a retrospective study. Osteoporos Int 2023; 34:573-584. [PMID: 36602607 PMCID: PMC9813893 DOI: 10.1007/s00198-022-06648-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 12/13/2022] [Indexed: 01/06/2023]
Abstract
A retrospective study of 121 patients who stopped denosumab (Dmab) then received no treatment (NT), risedronate (RIS), alendronate (ALN), or zoledronic acid (ZOL). Bone density (spine and hip) during and after Dmab discontinuation was measured. Treatment with ALN or ZOL, not NT and RIS, mitigated BMD loss after Dmab discontinuation. INTRODUCTION Denosumab (Dmab) discontinuation is associated with bone loss and multiple vertebral fractures. The purpose was to compare bone mineral density (BMD) change in patients following Dmab discontinuation with no subsequent treatment (NT) and three bisphosphonate (BP) treatments: risedronate (RIS), alendronate (ALN), and zoledronic acid (ZOL). METHODS In a review of 121 patients aged 71.2 ± 8.1 years, discontinuing Dmab (mean 5.4 doses), 33 received NT and 88 received BP (22 RIS; 34 ALN; 32 ZOL). BMD change after 1 year was compared between groups at the lumbar spine (LS), femoral neck (FN), and total hip (TH). Risk factors for bone loss after Dmab discontinuation were compared between groups and incidence of vertebral fractures was determined. RESULTS Following Dmab discontinuation, LS mean change (g/cm2; 95% CI) was for NT: - 0.041 (- 0.062 to - 0.021); RIS: - 0.035 (- 0.052 to - 0.017); ALN: - 0.005 (- 0.020 to 0.009); and ZOL: - 0.009 (- 0.025 to 0.008). Differences in LS were found between NT and ALN (p = 0.015), and NT and ZOL (p=0.037), but not between NT and RIS. The only significant difference in TH was found between NT and ZOL (p 0.034) with no group differences in FN. BMD gains during Dmab treatment were associated with BMD loss after Dmab discontinuation. In a subset, discontinuation after Dmab treatment (> 5 doses) followed by ALN (n = 22) and ZOL (n = 11) showed no difference in BMD. Five of 7 vertebral fractures occurred after Dmab discontinuation in NT. CONCLUSION Subsequent treatment with ALN or ZOL but not NT and RIS mitigates BMD loss after Dmab discontinuation.
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Affiliation(s)
- Teerapat Tutaworn
- Hospital for Special Surgery, New York, NY, USA
- Department of Orthopedic Surgery, Phramongkutkloa Hospital, Ratchathewi, Bangkok, Thailand
| | - Jeri W Nieves
- Hospital for Special Surgery, New York, NY, USA
- Department of Epidemiology, Columbia University, New York, NY, USA
| | - Zhaorui Wang
- Weill Cornell Medical College, New York, NY, USA
| | | | - Jae E Yoo
- Hospital for Special Surgery, New York, NY, USA
| | - Joseph M Lane
- Hospital for Special Surgery, New York, NY, USA.
- Weill Cornell Medical College, New York, NY, USA.
- Department of Orthopedic Surgery, Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021, USA.
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Mori S, Hagino H, Sugimoto T, Tanaka S, Mitomo Y, Takahashi K, Sone T, Nakamura T, Soen S. Sequential therapy with once-weekly teriparatide injection followed by alendronate versus monotherapy with alendronate alone in patients at high risk of osteoporotic fracture: final results of the Japanese Osteoporosis Intervention Trial-05. Osteoporos Int 2023; 34:189-199. [PMID: 36239756 PMCID: PMC9813198 DOI: 10.1007/s00198-022-06570-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 10/04/2022] [Indexed: 01/09/2023]
Abstract
UNLABELLED In this randomized, controlled trial, sequential therapy with once-weekly subcutaneous injection of teriparatide for 72 weeks, followed by alendronate for 48 weeks resulted in a significantly lower incidence of morphometric vertebral fracture than monotherapy with alendronate for 120 weeks in women with osteoporosis at high risk of fracture. PURPOSE To determine whether the anti-fracture efficacy of sequential therapy with teriparatide, followed by alendronate is superior to that of monotherapy with alendronate, a prospective, randomized, open-label, blinded-endpoint trial was performed. METHODS Japanese women aged at least 75 years were eligible for the study, if they had primary osteoporosis and if they were at high risk of fracture. Patients were randomly assigned (1:1) to receive the sequential therapy (once-weekly subcutaneous injection of teriparatide 56.5 μg for 72 weeks, followed by alendronate for 48 weeks) or monotherapy with alendronate for 120 weeks. The primary endpoint in the final analysis was the incidence of morphometric vertebral fracture during the 120-week follow-up period. RESULTS Between October 2014 and June 2020, 505 patients in the sequential therapy group and 506 in the monotherapy group were enrolled. Of these, 489 and 496, respectively, were included in the main analysis. The incidence of morphometric vertebral fracture during the 120-week follow-up period in the sequential therapy group (64 per 627.5 person-years, annual incidence rate 0.1020) was significantly lower than that in the monotherapy group (126 per 844.2 person-years, annual incidence rate 0.1492), with a rate ratio of 0.69 (95% confidence interval 0.54 to 0.88, P < 0.01). After 72 weeks, no patient had a severe adverse event that was considered related to the study drug. CONCLUSION Once-weekly injection of teriparatide, followed by alendronate resulted in a significantly lower incidence of morphometric vertebral fracture than alendronate monotherapy in women with osteoporosis who were at high risk of fracture. TRIAL REGISTRATION NUMBER, DATE OF REGISTRATION: jRCTs031180235 and UMIN000015573, March 12, 2019.
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Affiliation(s)
- Satoshi Mori
- Bone and Joint Surgery, Seirei Hamamatsu General Hospital, Shizuoka, Japan.
| | - Hiroshi Hagino
- School of Health Science, Faculty of Medicine, Tottori University, Tottori, Japan
| | | | - Shiro Tanaka
- Department of Clinical Biostatistics/Clinical Biostatistics Course, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yuji Mitomo
- Department of Clinical Biostatistics/Clinical Biostatistics Course, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kaito Takahashi
- Department of Clinical Biostatistics/Clinical Biostatistics Course, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Teruki Sone
- Department of Nuclear Medicine, Kawasaki Medical School, Okayama, Japan
| | | | - Satoshi Soen
- Soen Orthopaedics, Osteoporosis and Rheumatology Clinic, Kobe, Japan
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Shin JW, He Q, Suk YJ, Kim SH, Kim HS. Comparison of the efficacy between sequential therapy with teriparatide and denosumab and denosumab monotherapy in suppressing fragility fracture risk. Osteoporos Int 2022; 33:2409-2416. [PMID: 35925259 DOI: 10.1007/s00198-022-06495-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Accepted: 07/03/2022] [Indexed: 10/16/2022]
Abstract
UNLABELLED In this retrospective study, the effectiveness of short-term teriparatide with denosumab in reducing fragility fracture risk was determined in comparison with denosumab monotherapy. Administration of sequential teriparatide with denosumab showed excellent outcomes in suppressing the risk for fragility fractures compared with denosumab monotherapy. INTRODUCTION To determine the effectiveness of short-term teriparatide with denosumab in reducing the risk of fragility fractures in comparison to denosumab monotherapy. METHODS The data of postmenopausal patients treated with denosumab for > 2 years between August 2015 and October 2020 were retrospectively analyzed. One hundred sixty four postmenopausal women of a total 615 were excluded, since they did not undergo > 2 bone mineral density (BMD) tests, were lost to follow-up, or received long-term teriparatide therapy. Total 320 patients received denosumab monotherapy and 131 patients received teriparatide for ≥ 3 months followed by denosumab. The number of osteoporotic fractures, presence of back pain before and after treatment, and annual BMD during treatment were comparatively assessed using t-test, Chi-square test, and linear mixed model analysis. RESULTS Before treatment, the denosumab monotherapy group had fewer osteoporotic fractures (mean ± standard deviation; 0.459 ± 0.689) than the sequential therapy group had (1.037 ± 0.871; p < 0.001). After treatment, the sequential therapy group had fewer osteoporotic fractures than the denosumab monotherapy group had (0.119 ± 0.348 versus 0.144 ± 0.385; p < 0.001). At 1 and 2 years after treatment, the increase in lumbar spine BMD was greater in the sequential therapy group than in the denosumab monotherapy group (p = 0.08, group × time). The difference between post and pre-treatment back pain visual analog scale score was significantly lower in the sequential therapy group than in the monotherapy group (3.246 ± 3.426 versus 1.734 ± 3.049; p < 0.001). CONCLUSION Short-term teriparatide use before denosumab showed excellent outcomes in suppressing the risk of fragility fractures compared with denosumab monotherapy.
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Affiliation(s)
- Jae-Won Shin
- Department of Orthopedic Surgery, National Health Insurance Service Ilsan Hospital, 100 Ilsan-ro, Goyang, 10444, Republic of Korea
- Department of Orthopedic Surgery, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Quen He
- Department of Orthopedic Surgery, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Yong June Suk
- Department of Orthopedic Surgery, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Sang-Ho Kim
- Department of Orthopedic Surgery, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Hak-Sun Kim
- Department of Orthopedic Surgery, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.
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Duong LT, Clark S, Pickarski M, Giezek H, Cohn D, Massaad R, Stoch SA. Effects of odanacatib on bone-turnover markers in osteoporotic postmenopausal women: a post hoc analysis of the LOFT study. Osteoporos Int 2022; 33:2165-2175. [PMID: 35711006 DOI: 10.1007/s00198-022-06406-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 04/08/2022] [Indexed: 10/18/2022]
Abstract
UNLABELLED This post hoc analysis and modeling study examined the mechanism of action of odanacatib using a statistical model to explain sCTx response in ODN-treated patients as a function of other bone-turnover biomarkers that, with other observed biomarker changes, showed that odanacatib persistently inhibited osteoclastic bone removal activity without preventing osteoclastogenesis. INTRODUCTION Odanacatib (ODN) is an oral selective cathepsin K (CatK) inhibitor, previously in development for osteoporosis treatment. A post hoc analysis examined ODN's mechanism of action on bone-turnover biomarkers. METHODS A subset of patients who completed 60 months' treatment in the Long-Term Odanacatib Fracture Trial (LOFT; NCT00529373) (N = 112 [57 ODN, 55 placebo]) were evaluated. Serum (s) and urine (u) samples were assayed at baseline and months 6-60 for 10 known bone-remodeling biomarkers: sCTx, uαα- and uββCTx/Cr, uNTx/Cr, sNTx, uDPD/Cr, sICTP, sTRAP5b, sPINP, and sBSAP. Because the CrossLaps® CTx assay identifies the CTx peptide as well as larger molecular weight CTx-containing peptides, including ICTP, a best-fit model was developed to explain the transient sCTx reduction in ODN-treated patients. RESULTS ODN persistently reduced the bone-resorption markers sNTx, uNTx/Cr, uαα- and uββCTx/Cr, and uDPD/Cr, and gradually increased the target-engagement marker sICTP and osteoclast number (sTRAP5b), versus placebo from baseline to month 60. sCTx was transiently reduced with ODN within 12 months, returning to baseline by month 48. Modeling suggested that sCTx changes in the ODN group were primarily due to increased accumulation of larger CTx species, including sICTP. The bone-formation markers sPINP and sBSAP showed partial reductions, versus placebo, in the first 6 months but approached baseline by months 48-60. CONCLUSION Observed changes in bone-turnover biomarkers support the persistent efficacy of ODN in direct inhibition of osteoclastic bone-resorption activity, without inhibition of osteoclastogenesis. Long-term evaluation also underscores the unique mechanism of ODN on osteoclastic collagen processing and subsequently osteoblastic bone formation. TRIAL REGISTRATION NCT00529373.
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Affiliation(s)
| | - S Clark
- Merck & Co., Inc., Rahway, NJ, USA.
| | | | - H Giezek
- MSD Europe Inc., Brussels, Belgium
| | - D Cohn
- Merck & Co., Inc., Rahway, NJ, USA
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10
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Matsumoto T, Sone T, Soen S, Tanaka S, Yamashita A, Inoue T. Abaloparatide Increases Lumbar Spine and Hip BMD in Japanese Patients With Osteoporosis: The Phase 3 ACTIVE-J Study. J Clin Endocrinol Metab 2022; 107:e4222-e4231. [PMID: 35977548 PMCID: PMC9516124 DOI: 10.1210/clinem/dgac486] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Indexed: 11/19/2022]
Abstract
CONTEXT Abaloparatide reduced fracture risk in postmenopausal women with osteoporosis in the Abaloparatide Comparator Trial In Vertebral Endpoints (ACTIVE). Its effect in Japanese patients remains unexamined. OBJECTIVE This work aimed to determine the efficacy and safety of abaloparatide in increasing bone mineral density (BMD) in Japanese patients with osteoporosis at high fracture risk. METHODS This was a randomized, double-blind, placebo-controlled study conducted in Japan. Postmenopausal women and men with osteoporosis with high fracture risk were given daily subcutaneous 80 µg abaloparatide or placebo for 78 weeks (18 months). The primary end point was percentage change in lumbar spine (LS) BMD from baseline at the last visit. Secondary end points included time-course changes in LS, total hip (TH), and femoral neck (FN) BMDs and bone turnover markers, and cumulative number of fractures. RESULTS Abaloparatide increased LS, TH, and FN BMDs (mean [95% CI]) by 12.5% (10.3%-14.8%; P < .001), 4.3% (3.3%-5.3%), and 4.3% (2.9%-5.6%), respectively, vs placebo. Serum procollagen type I N-terminal propeptide increased rapidly to ~ 140% above baseline at 6 weeks and gradually decreased but was approximately 25% higher than baseline at 78 weeks. Serum carboxy-terminal cross-linking telopeptide of type I collagen gradually increased to 50% above baseline at 24 weeks and decreased gradually to the placebo-group level from 60 weeks. Four vertebrae of 3 participants in the placebo group, but none in the abaloparatide group, developed new vertebral fractures. The safety profile was similar to that in the ACTIVE study. CONCLUSION In Japanese patients with postmenopausal and male osteoporosis with high fracture risk, abaloparatide for 78 weeks robustly increased LS, TH, and FN BMDs, suggesting a similar efficacy in Japanese patients vs the ACTIVE study population.
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Affiliation(s)
- Toshio Matsumoto
- Correspondence: Toshio Matsumoto, MD, PhD, Fujii Memorial Institute of Medical Sciences, Tokushima University, 3-18-15 Kuramoto-cho, Tokushima 770-8503, Japan.
| | - Teruki Sone
- Department of Nuclear Medicine, Kawasaki Medical School, Okayama 701-0952, Japan
| | - Satoshi Soen
- Soen Orthopaedics, Osteoporosis and Rheumatology Clinic, Hyogo 658-0072, Japan
| | - Sakae Tanaka
- Department of Orthopedic Surgery, The University of Tokyo, Tokyo 113-0033, Japan
| | - Akiko Yamashita
- Division of Pharmaceutical Development and Production, Teijin Pharma Limited, Tokyo 100-8585, Japan
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11
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Rhee Y, Chang DG, Ha J, Kim S, Lee Y, Jo E, Koh JM. Real-World Safety and Effectiveness of Denosumab in Patients with Osteoporosis: A Prospective, Observational Study in South Korea. Endocrinol Metab (Seoul) 2022; 37:497-505. [PMID: 35654577 PMCID: PMC9262695 DOI: 10.3803/enm.2022.1427] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 05/02/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGRUOUND The efficacy and safety of denosumab have been established in a phase 3, randomized, placebo-controlled trial in Korean postmenopausal women with osteoporosis. This postmarketing surveillance study was aimed to investigate the safety and effectiveness of denosumab in Korean real-world clinical practice. METHODS Patients with osteoporosis who had received denosumab per the Korean approved indications in the postmarketing setting between September 2014 and September 2019 were enrolled. The primary endpoint was the incidence of adverse events (AEs) and adverse drug reactions (ADRs). The secondary endpoint was the percent change from baseline in bone mineral density (BMD) of the lumbar spine, total hip, and femoral neck. RESULTS Of the 3,221 patients enrolled, 3,185 were included in the safety analysis set; 2,973 (93.3%) were female, and the mean± standard deviation (SD) age was 68.9±9.9 years. The mean±SD study period was 350.0±71.4 days. AEs, fatal AEs, and ADRs occurred in 19.3%, 0.8%, and 1.6%, respectively. The most frequent AEs, occurring in >0.5% of patients, were dizziness (0.7%), arthralgia (0.7%), back pain (0.6%), and myalgia (0.6%). Hypocalcemia occurred in 0.3% of patients. There were no cases of osteonecrosis of the jaw and atypical femoral fracture. Mean±SD percent change from baseline in BMD of the lumbar spine, total hip, and femoral neck was 7.3%±23.6%, 3.6%±31.4%, and 3.2%±10.7%, respectively. CONCLUSION The safety and effectiveness of denosumab in Korean patients with osteoporosis in this study were comparable with those in the Korean randomized controlled trial, with no new safety findings.
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Affiliation(s)
- Yumie Rhee
- Department of Internal Medicine, Severance Hospital, Endocrine Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Dong-Gune Chang
- Department of Orthopedic Surgery, Inje University Sanggye Paik Hospital, College of Medicine, Inje University, Seoul, Korea
| | - Jeonghoon Ha
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | | | | | - Euna Jo
- Amgen Korea Ltd., Seoul, Korea
| | - Jung-Min Koh
- Division of Endocrinology and Metabolism, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- Corresponding author: Jung-Min Koh Division of Endocrinology and Metabolism, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea Tel: +82-2-3010-3247, Fax: +82-2-3010-6962, E-mail:
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12
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Tominaga A, Wada K, Okazaki K, Nishi H, Terayama Y, Kodama Y, Kato Y. Effect of the duration of previous osteoporosis treatment on the effect of romosozumab treatment. Osteoporos Int 2022; 33:1265-1273. [PMID: 35059774 DOI: 10.1007/s00198-021-06261-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 12/02/2021] [Indexed: 01/19/2023]
Abstract
UNLABELLED The effect of romosozumab is affected by previous osteoporosis treatment. Here we showed that the duration of the previous treatment just before romosozumab affects the therapeutic effect of romosozumab. Using denosumab and oral bisphosphonates for more than 1 year attenuates the effect of romosozumab. INTRODUCTION As an anti-sclerostin antibody, romosozumab suppresses bone resorption and stimulates bone formation. We investigated whether the effectiveness of 12 months of romosozumab treatment depended on the duration of previous treatment with teriparatide, denosumab, or oral bisphosphonates. METHODS In total, 259 osteoporosis patients received subcutaneous injections of romosozumab (210 mg) every 4 weeks during 2019 and 2020. This study was designed as a pre-post comparison. The end points were the percent changes of bone mineral density (BMD) after 12 months of romosozumab treatment. The patients were divided into seven groups depending on the type and duration of previous treatment before starting romosozumab as follows: non-previous treatment group, change from teriparatide used for 1 year or less/more than 1 year, change from denosumab used for 1 year or less/more than 1 year, and change from oral bisphosphonates used for 1 year or less/more than 1 year. RESULTS The effects of previous treatment with teriparatide on the effectiveness of 12-month romosozumab did not clearly depend on the duration of treatment (p > 0.05). In contrast, the effects of previous treatments with denosumab or oral bisphosphonates on the effectiveness of 12-month romosozumab depended on the previous treatment duration, which was reflected by the differences in percent change of the spine BMD (both p < 0.05), however, there were no significant differences in the percent change of the total hip BMD (both p > 0.05). CONCLUSION The duration of the previous treatment affected the effectiveness of romosozumab. Using denosumab and oral bisphosphonate for more than 1 year attenuated the effect of romosozumab.
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Affiliation(s)
- A Tominaga
- Department of Orthopedic Surgery, Tokyo Women's Medical University, 8-1 Kawadacho Shinjuku-ku, Tokyo, Japan
| | - K Wada
- Department of Orthopedic Surgery, Tokyo Women's Medical University, 8-1 Kawadacho Shinjuku-ku, Tokyo, Japan.
| | - K Okazaki
- Department of Orthopedic Surgery, Tokyo Women's Medical University, 8-1 Kawadacho Shinjuku-ku, Tokyo, Japan
| | - H Nishi
- Hasuda Hospital, 1662-1 Negane Hasudashi, Saitama, Japan
| | - Y Terayama
- Hasuda Hospital, 1662-1 Negane Hasudashi, Saitama, Japan
| | - Y Kodama
- Ohara Clinic, 2-23-19 Ohara Setagaya-ku, Tokyo, Japan
| | - Y Kato
- Kita Shinagawa 3rd Hospital, 3-3-7 Kitashinagawa Shinagawa-ku, Tokyo, Japan
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13
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Peng C, Tian R, Li L, Zhu YK, Li SY, Ye SD, He L, Niu JP, Zhang Q, Zhou YF. [A randomized double-blinded placebo-controlled clinical trial of minodronate tablet in postmenopausal Chinese women with osteoporosis]. Zhonghua Fu Chan Ke Za Zhi 2022; 57:346-351. [PMID: 35658325 DOI: 10.3760/cma.j.cn112141-20220220-00108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Objective: To verify the efficacy and safety of daily oral minodronate in postmenopausal women with established osteoporosis. Methods: In this randomized, double-blinded, placebo-controlled trial, 262 postmenopausal women were enrolled. Patients were randomized to receive daily oral minodronate 1 mg with supplements of 500 mg calcium and 200 U vitamin D3 (n=130) or placebo (n=132) with daily supplements of 500 mg calcium and 200 U vitamin D3, for 48 weeks. The primary endpoint was the average bone mineral density (BMD) change in the lumbar vertebrae 48 weeks post-treatment. Secondary outcome measures was the incidence of vertebral fractures. Safety assessments included the rate of adverse events. Results: At the end of 48 weeks treatment, the average BMD change rate from baseline were: full analysis set results: (3.52±4.82)% in the minodronate group and (2.00±5.74)% in the placebo group; per-protocol set results: (3.99±5.05)% in the minodronate group and (2.07±6.20)% in the placebo group; the differences were all significant (all P<0.05). Vertebral fracture occured in 3 patients (2.3%, 3/132) in the placebo group, and 1 case (0.8%, 1/130) in the minodronate group (P>0.05). The incidence of adverse events was 71.5% (93/130) in the minodronate group and 78.0% (103/132) in the placebo group (P>0.05). Conclusion: Minodronate is effective and safe in the treatment of postmenopausal osteoporosis without severe side effects.
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Affiliation(s)
- C Peng
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing 100034, China
| | - R Tian
- Department of Orthopedics, Tianjin People's Hospital, Tianjin 300121, China
| | - L Li
- Department of Endocrinology, Shengjing Hospital of China Medical University, Shenyang 110004, China
| | - Y K Zhu
- Department of Endocrinology, The Second Hospital of Shanxi Medical University, Taiyuan 030001, China
| | - S Y Li
- Department of Endocrinology, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - S D Ye
- Department of Endocrinology, Anhui Provincial Hospital, Hefei 230001, China
| | - L He
- Department of Orthopedics, Beijing Jishuitan Hospital, Beijing 100035, China
| | - J P Niu
- Department of Endocrinology, The Affiliated Hospital of Qingdao University, Qingdao 266003, China
| | - Q Zhang
- Department of Endocrinology, First Affiliated Hospital of Anhui Medical University, Hefei 230022, China
| | - Y F Zhou
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing 100034, China
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14
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Tay WL, Tay D. Discontinuing Denosumab: Can It Be Done Safely? A Review of the Literature. Endocrinol Metab (Seoul) 2022; 37:183-194. [PMID: 35417954 PMCID: PMC9081316 DOI: 10.3803/enm.2021.1369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 02/17/2022] [Accepted: 02/22/2022] [Indexed: 11/30/2022] Open
Abstract
Denosumab, which has been approved for the treatment of osteoporosis since 2010, is a fully humanised monoclonal antibody against a cytokine, receptor activator of nuclear factor kappa B ligand (RANKL), involved in bone resorption. Continued use of denosumab results in a potent and sustained decrease in bone turnover, an increase in bone mineral density (BMD), and a reduction in vertebral and hip fractures. The anti-resorptive effects of denosumab are reversible upon cessation, and this reversal is accompanied by a transient marked increase in bone turnover that is associated with bone loss, and of concern, an increased risk of multiple vertebral fractures. In this review, we outline the effects of denosumab withdrawal on bone turnover markers, BMD, histomorphometry, and fracture risk. We provide an update on recent clinical trials that sought to answer how clinicians can transition away from denosumab safely with follow-on therapy to mitigate bone loss and summarise the recommendations of various international guidelines.
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Affiliation(s)
- Wei Lin Tay
- Department of General Medicine, Sengkang General Hospital, Singhealth, Singapore
- Duke NUS Medical School, Singapore
| | - Donovan Tay
- Department of General Medicine, Sengkang General Hospital, Singhealth, Singapore
- Duke NUS Medical School, Singapore
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15
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McDonough A, Malomo K, Brennan F, Fallon N, Steen G, Maher N, O'Carroll C, Walsh JB, Lannon R, McCarroll K. Treatment Challenges When Stopping Denosumab. Ir Med J 2022; 115:567. [PMID: 35532944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Introduction Denosumab is commonly used to treat osteoporosis. However, discontinuation results in rebound bone loss and increased vertebral fracture risk. We report a clinical case series, illustrating the dilemma in deciding the best treatment should denosumab be stopped. Cases In eight patients aged 56-89 years, zolendronic acid after stopping denosumab resulted in BTM rises and BMD decline. In a 68-year-old, two years of oral bisphosphonate after three years of denosumab resulted in elevated bone turnover markers (BTM) and decline in bone mineral density (BMD), necessitating a switch to zoledronic acid. In a 79-year-old, two annual doses of zolendronic acid after three years of denosumab failed to suppress high BTM, with BMD dropping and denosumab being restarted. In a 60-year-old, on stopping denosumab after 10 years of oral bisphosphonate, BMD remained stable despite no further therapy. Conclusion Drug holidays are not an option with denosumab, with a risk of bone loss even on transitioning to bisphosphonates. Risk is greater with longer duration of treatment6 and may be mitigated by prior bisphosphonate use. Standard dose zoledronic acid does not prevent bone loss in a significant proportion of patients. BTM may help in monitoring treatment and need for further bisphosphonates.
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Affiliation(s)
- A McDonough
- Bone Health and Osteoporosis Unit, Mercer's Institute for Successful Ageing, St. James's Hospital
| | - K Malomo
- Bone Health and Osteoporosis Unit, Mercer's Institute for Successful Ageing, St. James's Hospital
| | - F Brennan
- Bone Health and Osteoporosis Unit, Mercer's Institute for Successful Ageing, St. James's Hospital
| | - N Fallon
- Bone Health and Osteoporosis Unit, Mercer's Institute for Successful Ageing, St. James's Hospital
| | - G Steen
- Bone Health and Osteoporosis Unit, Mercer's Institute for Successful Ageing, St. James's Hospital
| | - N Maher
- Bone Health and Osteoporosis Unit, Mercer's Institute for Successful Ageing, St. James's Hospital
| | - C O'Carroll
- Bone Health and Osteoporosis Unit, Mercer's Institute for Successful Ageing, St. James's Hospital
| | - J B Walsh
- Bone Health and Osteoporosis Unit, Mercer's Institute for Successful Ageing, St. James's Hospital
| | - R Lannon
- Bone Health and Osteoporosis Unit, Mercer's Institute for Successful Ageing, St. James's Hospital
| | - K McCarroll
- Bone Health and Osteoporosis Unit, Mercer's Institute for Successful Ageing, St. James's Hospital
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16
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Geusens P, Feldman R, Oates M, Thomas T, Makras P, Jakob F, Langdahl B, Wang Z, Rojeski M, Libanati C. Romosozumab reduces incidence of new vertebral fractures across severity grades among postmenopausal women with osteoporosis. Bone 2022; 154:116209. [PMID: 34547521 DOI: 10.1016/j.bone.2021.116209] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 09/07/2021] [Accepted: 09/16/2021] [Indexed: 11/17/2022]
Abstract
Vertebral fractures (VFs) are the most common type of osteoporotic fracture, and their prevalence and severity are key risk factors for future fragility fractures. Here, we assess the treatment effect of romosozumab on the incidence of new on-study VFs according to Genant severity grades (mild, moderate, and severe). Data are reported from two phase 3 clinical studies for patients who received romosozumab versus placebo through 12 months, followed by denosumab through 24 months (FRAME: NCT01575834), and for patients who received romosozumab through 12 months, followed by alendronate through 24 months, versus alendronate only through 24 months (ARCH: NCT01631214). The treatment effect of romosozumab is reported for all included patients, and for patients with prevalent and severe baseline VFs. The incidence of new moderate-or-severe VFs was reduced through 12 months for patients treated with romosozumab versus placebo (FRAME; 0.25% versus 1.42%, respectively; p < 0.001) or alendronate (ARCH; 2.78% versus 4.00%, respectively; p = 0.042). Furthermore, the treatment effect of romosozumab on the incidence of new VFs across moderate and severe severity grades was independent of baseline VF prevalence or severity; through 12 months, consistent reductions in new moderate-or-severe VFs were observed regardless of prevalent (FRAME; p = 0.18) or severe (ARCH; p = 0.52) VFs at baseline. Reductions in the incidence of new moderate and severe VFs were sustained through 24 months, after transition from romosozumab to denosumab or alendronate, independent of baseline VF prevalence or severity; no significant interactions were observed between the incidence of new moderate-or-severe VFs and the presence of prevalent (FRAME; p = 0.81) or severe (ARCH; p = 0.99) VFs at baseline. With increasing recommendations for initial treatment with bone-forming agents for postmenopausal women with osteoporosis, these analyses will help to inform treatment decisions for patients at very high risk of VF.
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Affiliation(s)
- Piet Geusens
- Maastricht University Medical Center, Maastricht, the Netherlands; University Hasselt, Belgium.
| | | | | | - Thierry Thomas
- Hopital Nord, CHU Saint-Etienne, Saint-Etienne and INSERM 1059, Universite de Lyon, Saint-Etienne, France
| | - Polyzois Makras
- 251 Hellenic Air Force & VA-General Hospital, Athens, Greece
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Abstract
Osteoporosis is an incurable chronic condition, like heart disease, diabetes, or hypertension. A large gap currently exists in the primary prevention of fractures, and studies show that an estimated 80% to 90% of adults do not receive appropriate osteoporosis management even in the secondary prevention setting. Case finding strategies have been developed and effective pharmacological interventions are available. This publication addresses how best to use the pharmacological options available for postmenopausal osteoporosis to provide lifelong fracture protection in patients at high and very high risk of fracture. The benefit of osteoporosis therapies far outweighs the rare risks.
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Affiliation(s)
- Jacques P Brown
- Division of Rheumatology, Department of Medicine, Laval University, Quebec City, QC, Canada
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Broadwell A, Chines A, Ebeling PR, Franek E, Huang S, Smith S, Kendler D, Messina O, Miller PD. Denosumab Safety and Efficacy Among Participants in the FREEDOM Extension Study With Mild to Moderate Chronic Kidney Disease. J Clin Endocrinol Metab 2021; 106:397-409. [PMID: 33211870 PMCID: PMC7823314 DOI: 10.1210/clinem/dgaa851] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Indexed: 12/23/2022]
Abstract
CONTEXT The effects of long-term exposure to denosumab in individuals with renal insufficiency are unknown. OBJECTIVE This post hoc analysis evaluates the long-term safety and efficacy of denosumab in individuals with mild-to-moderate chronic kidney disease (CKD) (stages 2 and 3) using data from the pivotal phase 3, double-blind, 3-year FREEDOM (NCT00089791) and open-label, 7-year extension (NCT00523341) studies. PARTICIPANTS AND METHODS Women age 60 to 90 years with a bone mineral density (BMD) T-score of less than -2.5 to greater than -4.0 at the total hip or lumbar spine were randomly assigned 1:1 to receive denosumab 60 mg subcutaneously every 6 months (long-term arm) or placebo (cross-over arm) in FREEDOM; eligible participants could enroll in the extension to receive denosumab 60 mg subcutaneously every 6 months. Change in estimated glomerular filtration rate (eGFR) from study baseline and annualized rates of fracture and adverse events (AEs) were the main outcome measures. RESULTS Most participants (1259/1969 [64%] long-term arm; 1173/1781 [66%] crossover arm) with baseline CKD stage 2 or 3 remained within the same CKD subgroup at study completion; less than 3% progressed to CKD stage 4. Participants in all eGFR subgroups showed similar, persistent BMD gains over time and a low incidence of fractures. The percentage of participants reporting serious AEs was similar among renal subgroups (normal, CKD stage 2, CKD stage 3a, CKD stage 3b) both for the long-term (54% vs 52% vs 57% vs 58%) and crossover (43% vs 42% vs 43% vs 68%) arms, except CKD stage 3b subgroup, crossover arm. CONCLUSION The safety and efficacy of denosumab did not differ among participants with mild to moderate CKD.
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Affiliation(s)
- Aaron Broadwell
- Rheumatology and Osteoporosis Specialists, Shreveport, Louisiana, USA
- Correspondence and Reprint Requests: Aaron Broadwell, MD, Rheumatology and Osteoporosis Specialists, 820 Jordan St, Ste 201, Shreveport, LA 71101, USA. E-mail:
| | | | | | - Edward Franek
- Mossakowski Medical Research Centre, Polish Academy of Sciences, Warsaw, Poland
| | | | | | - David Kendler
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Paul D Miller
- Colorado Center for Bone Research, Lakewood, Colorado, USA
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Catalano A, Gaudio A, Agostino RM, Morabito N, Bellone F, Lasco A. Trabecular bone score and quantitative ultrasound measurements in the assessment of bone health in breast cancer survivors assuming aromatase inhibitors. J Endocrinol Invest 2019; 42:1337-1343. [PMID: 31127591 DOI: 10.1007/s40618-019-01063-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 05/10/2019] [Indexed: 12/11/2022]
Abstract
PURPOSE Aromatase inhibitors (AIs) represent the first-line adjuvant therapy for hormone receptor-positive breast cancer (BC) women. AIs have been associated with an increased rate of fractures. The aim of our study was to investigate trabecular bone score (TBS) and bone quantitative ultrasound (QUS) measurements as bone quality surrogates in AIs users. METHODS Sixty postmenopausal BC women starting AIs and forty-two controls (mean age 61.64 ± 8.33 years) were considered. Bone mineral density (BMD) at lumbar spine and femoral neck and TBS were measured by DXA; QUS-derived Amplitude-Dependent Speed of Sound (AD-SoS), Bone Transmission Time (BTT), and Ultrasound Bone Profile Index (UBPI) were assessed at phalangeal site; morphometric vertebral fractures (Vfx) by X-ray, serum bone-specific alkaline phosphatase (BSAP), and C-telopeptide of type 1 collagen (CTX) were also evaluated. RESULTS After 18 months, changes of TBS vs baseline were significantly different between AIs group and controls [Δ TBS - 2.2% vs - 0.4%, respectively, p = 0.001]. AD-SoS, BTT and UBPI values decreased only in AIs' group (- 3.7%, - 6.45%, -8.5%, vs baseline, respectively, pall < 0.001). 3 Vfx occurred in AIs users and were associated with the greater TBS and AD-SoS modifications. In the AIs' group, ΔTBS was associated with ΔAD-SoS (r = 0.58, p < 0.001) and ΔUBPI (r = 0.415, p = 0.001), but not with ΔBMD. Moreover, ΔTBS was independently predicted by ΔAD-SoS, after correcting for BMD, CTX and BSAP level changes (β = 0.37, SE = 2.44, p < 0.001). CONCLUSIONS TBS and phalangeal QUS provide useful information related to bone quality in AI-treated BC survivors and could be considered for fracture risk evaluation.
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Affiliation(s)
- A Catalano
- Department of Clinical and Experimental Medicine, University Hospital of Messina, Via C. Valeria, 98125, Messina, Italy.
| | - A Gaudio
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - R M Agostino
- Medical Oncology Unit, Grand Metropolitan Hospital "Bianchi Melacrino Morelli", Reggio Calabria, Italy
| | - N Morabito
- Department of Clinical and Experimental Medicine, University Hospital of Messina, Via C. Valeria, 98125, Messina, Italy
| | - F Bellone
- Department of Clinical and Experimental Medicine, University Hospital of Messina, Via C. Valeria, 98125, Messina, Italy
| | - A Lasco
- Department of Clinical and Experimental Medicine, University Hospital of Messina, Via C. Valeria, 98125, Messina, Italy
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Baatjes KJ, Kotze MJ, McCaul M, Conradie M. Baseline bone health status in multi-ethnic South African postmenopausal breast cancer patients at initiation of aromatase inhibitor therapy: A descriptive study. PLoS One 2019; 14:e0214153. [PMID: 30939140 PMCID: PMC6445512 DOI: 10.1371/journal.pone.0214153] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 03/07/2019] [Indexed: 12/21/2022] Open
Abstract
Introduction Osteoporosis (OP) risk factor assessment and bone mineral density (BMD) testing are frequently omitted at baseline in aromatase inhibitor (AI) studies, which may lead to misinterpretation of AI associated bone loss. The present study describes bone health of South African postmenopausal women of predominantly Mixed Ancestry, prior to AI treatment. Methods This descriptive baseline study, nested in a prospective AI cohort study, included postmenopausal women with endocrine sensitive breast cancer, aged 50 to 80 years. A baseline questionnaire documented demographic-, medical-, lifestyle- and fracture history. Body weight was assessed clinically, and body composition and BMD measured via dual energy absorptiometry (DXA). Data was analysed in STATA 14 using descriptive and inferential statistics. Results 101 participants were recruited, with a mean age of 61±7 years. Nearly a third (n = 32) of women at baseline fulfilled global criteria for bone protection (BMD T-score ≥-2SD (n = 18); BMD T-score -1.5SD to < -2SD with risk factors (n = 14). Lower body weight, body mass index (BMI), fat mass index and lean mass index were significantly associated with the participants with a BMD measurement in keeping with a diagnosis of OP (p <0.001). Low vitamin D was present in 93% of the cohort tested (n = 95), whilst deficient vitamin D status (<20ng/ml) was documented in 52 women (55%). Conclusions In this study, a third of postmenopausal women considered for AI therapy fulfilled international criteria for bone protective pharmacological intervention. This emphasizes the need for clinical risk and BMD assessment in postmenopausal breast cancer patients at baseline. Body composition and bone health associations highlight bone fragility associated with lower body weight.
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Affiliation(s)
- Karin J. Baatjes
- Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
- * E-mail:
| | - Maritha J. Kotze
- Division of Chemical Pathology, Department of Pathology Faculty of Medicine and Health Sciences, Stellenbosch University and the National Health Laboratory Service, Tygerberg Hospital, Tygerberg, South Africa
| | - Micheal McCaul
- Biostatistics Unit, Division of Epidemiology and Biostatistics, Department of Global Health, Stellenbosch University, Tygerberg, South Africa
| | - Magda Conradie
- Division of Endocrinology, Department of Medicine, Faculty of Medicine and Health Sciences Stellenbosch University, Tygerberg, South Africa
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Moriwaki K, Fukuda H. Cost-effectiveness of implementing guidelines for the treatment of glucocorticoid-induced osteoporosis in Japan. Osteoporos Int 2019; 30:299-310. [PMID: 30610244 DOI: 10.1007/s00198-018-4798-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 12/03/2018] [Indexed: 11/24/2022]
Abstract
UNLABELLED A model-based cost-effectiveness analysis was performed to evaluate the cost-effectiveness of implementing the clinical guideline for the treatment for glucocorticoid-induced osteoporosis (GIO). The treatment indication for GIO in the current Japanese clinical guidelines is likely to be cost-effective except for the limited patients who are at low risk for fracture. INTRODUCTION The purpose of this study was to evaluate the cost-effectiveness of implementing the clinical guideline for the treatment for glucocorticoid-induced osteoporosis (GIO) from the perspective of the Japanese healthcare system. METHODS A patient-level state transition model was developed to predict lifetime costs and quality-adjusted life years (QALYs) in postmenopausal Japanese women with osteopenia or osteoporosis using glucocorticoid (GC). An annual discount rate of 2% for both costs and QALYs was applied. The incremental cost-effectiveness ratio (ICER) of 5-year alendronate therapy compared with no therapy was estimated with different combinations of the risk factors such as starting age (45, 55, or 65), femoral neck BMD (% young adult mean (YAM) of 70%, 75%, or 80%), dose of GC (2.5, 5, or 10 mg per day), and the presence of previous fracture (yes or no). RESULTS For 55-year-old women using GC with a BMD of 75% of YAM, the ICER ranged from $10,958 to $ 29,727 per QALY. Scenario analyses indicated that the lower age, the lower BMD, the higher dose of GC, and the presence of previous fracture associated with lower ICER. The best-case scenario was 45-year-old women with a BMD of 70% of YAM, GC dose of 10 mg per day, and previous fracture, and resulted in healthcare cost-savings. The worst-case scenario was 65-year-old women with a BMD of 80% of YAM, GC dose of 2.5 mg per day, and no previous fracture, and resulted in the ICER of $66,791 per QALY. Sensitivity analyses in the worst-case scenario showed that the annual discount rate for costs and health benefit had the strong influence on the estimated ICER. Although the ICER was influenced by other parameters such as disutility due to vertebral fracture, efficacy of alendronate, and so on, the ICERs remained more than $50,000 per QALY. CONCLUSIONS The cost-effectiveness of preventive alendronate therapy for postmenopausal women with osteopenia or osteoporosis using GC is sensitive to age, BMD, GC dose, and the presence of previous fracture. Our analysis suggested that the treatment indication for postmenopausal women with osteopenia or osteoporosis using GC in the current Japanese clinical guidelines is likely to be cost-effective except for the limited patients who are at low risk for fracture.
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Affiliation(s)
- K Moriwaki
- Laboratory of Medical Statistics, Kobe Pharmaceutical University, 4-19-1, Motoyamakita, Higashinada, Kobe, 658-8558, Japan.
| | - H Fukuda
- Department of Health Care Administration and Management, Kyushu University Graduate School of Medical Sciences, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
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Hamood R, Hamood H, Merhasin I, Keinan-Boker L. Hormone therapy and osteoporosis in breast cancer survivors: assessment of risk and adherence to screening recommendations. Osteoporos Int 2019; 30:187-200. [PMID: 30413856 DOI: 10.1007/s00198-018-4758-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 10/30/2018] [Indexed: 02/07/2023]
Abstract
UNLABELLED The long-term impact of hormone therapy for breast cancer on risk of osteoporosis and the extent to which bone screening recommendations are implemented in daily practice remain unknown. We found that the aromatase inhibitor-induced risk of osteoporosis did not continue in the off-treatment follow-up. Adherence to screening recommendations was suboptimal. INTRODUCTION A case-cohort study was undertaken to better understand the impact of hormone therapy on breast cancer patients' risk of osteoporosis, and to estimate the extent to which current bone mineral density screening recommendations are implemented in real-life daily practice. METHODS This study is based on 1692 female breast cancer survivors recruited from "Leumit" healthcare fund, who were diagnosed with primary nonmetastatic invasive breast cancer between 2002 and 2012. A 20% random subcohort was sampled at baseline, and all osteoporosis cases were identified. Adjusted hazard ratios (HR) with 95% confidence intervals (CI) were estimated by weighted Cox proportional hazards models. RESULTS Of 1692 breast cancer survivors, 312 developed osteoporosis during a median follow-up of 5 years. The crude cumulative incidence of osteoporosis accounting for death as a competing risk was 25.7% (95% CI, 21.9-29.5%). In multivariable analyses, osteoporosis was positively associated with the aromatase inhibitor (AI) sequential treatment after tamoxifen (HR, 3.14; 95% CI, 1.44-6.88; P = .004) but was more pronounced with AI use as upfront monotherapy (HR, 5.53; 95% CI, 1.46-20.88; P = .012). This effect did not continue in the off-treatment follow-up. In subgroup analysis by menopausal status, tamoxifen did not seem to confer a protective effect on bone health in postmenopausal patients. Adherence to screening recommendations in AI-treated postmenopausal women was suboptimal, particularly at baseline and after 48 months of continuous AI use. CONCLUSIONS The natural, age-related reduction in bone density is exacerbated by breast cancer active AI treatment. Future research should focus on investigating screening adherence-related barriers/facilitators and effective strategies to bring practice in line with agreed standards.
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Affiliation(s)
- R Hamood
- School of Public Health, University of Haifa, Haifa, Israel
| | - H Hamood
- School of Public Health, University of Haifa, Haifa, Israel.
- Leumit Health Services, Haharoshet 13, Karmiel, Israel.
| | | | - L Keinan-Boker
- School of Public Health, University of Haifa, Haifa, Israel
- Ministry of Health, Israel Center for Disease Control, Ramat Gan, Israel
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Liu Y, Dimango E, Bucovsky M, Agarwal S, Nishiyama K, Guo XE, Shane E, Stein EM. Abnormal microarchitecture and stiffness in postmenopausal women using chronic inhaled glucocorticoids. Osteoporos Int 2018; 29:2121-2127. [PMID: 29947865 PMCID: PMC6138454 DOI: 10.1007/s00198-018-4591-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 05/27/2018] [Indexed: 12/19/2022]
Abstract
UNLABELLED Postmenopausal (PM) women using inhaled glucocorticoids (IGCs) had substantial abnormalities in volumetric BMD (vBMD), microarchitecture, and stiffness using high resolution peripheral computed tomography (HRpQCT) compared to age- and race-matched controls. Abnormalities were most severe at the radius. These preliminary results suggest that there may be major, heretofore unrecognized, skeletal deficits in PM women using IGCs. INTRODUCTION While oral glucocorticoids are well recognized to have destructive skeletal effects, less is known about the effects of IGCs. The detrimental skeletal effects of IGCs may be greatest in PM women, in whom they compound negative effects of estrogen loss and aging. The goal of this study was to evaluate microarchitecture and stiffness in PM women using chronic IGCs. METHODS This case-control study compared PM women using IGCs for ≥ 6 months (n = 20) and controls matched for age and race/ethnicity (n = 60). Skeletal parameters assessed included areal BMD (aBMD) by DXA, trabecular and cortical vBMD and microarchitecture by HRpQCT of the radius and tibia, and whole bone stiffness by finite element analysis. RESULTS By DXA, mean values in both groups were in the osteopenic range; hip aBMD was lower in IGC users (P < 0.04). By HRpQCT, IGC users had lower total, cortical, and trabecular vBMD at both radius and tibia (all P < 0.05). IGC users had lower cortical thickness, lower trabecular number, greater trabecular separation and heterogeneity at the radius (all P < 0.03), and greater heterogeneity at the tibia (P < 0.04). Whole bone stiffness was lower in IGC users at radius (P < 0.03) and tended to be lower at the tibia (P = 0.09). CONCLUSIONS PM women using IGCs had substantial abnormalities in vBMD, microarchitecture, and stiffness compared to controls. These abnormalities were most severe at the radius. These preliminary results suggest that there may be major, heretofore unrecognized, skeletal deficits in PM women using IGCs.
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Affiliation(s)
- Y Liu
- Division of Endocrinology and Metabolic Bone Disease, Hospital for Special Surgery, Weill Cornell Medical College, 535 East 70th Street, New York, NY, 10021, USA
| | - E Dimango
- Division of Pulmonology, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - M Bucovsky
- Division of Endocrinology, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - S Agarwal
- Division of Endocrinology, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - K Nishiyama
- Division of Endocrinology, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - X E Guo
- Bone Bioengineering Laboratory, Department of Biomedical Engineering, Columbia University, New York, NY, USA
| | - E Shane
- Division of Endocrinology, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - E M Stein
- Division of Endocrinology and Metabolic Bone Disease, Hospital for Special Surgery, Weill Cornell Medical College, 535 East 70th Street, New York, NY, 10021, USA.
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Parveen B, Tiwari AK, Jain M, Pal S, Chattopadhyay N, Tripathi M, Vohora D. The anti-epileptic drugs valproate, carbamazepine and levetiracetam cause bone loss and modulate Wnt inhibitors in normal and ovariectomised rats. Bone 2018; 113:57-67. [PMID: 29758362 DOI: 10.1016/j.bone.2018.05.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 04/23/2018] [Accepted: 05/11/2018] [Indexed: 01/21/2023]
Abstract
Secondary osteoporosis is the major concern associated with long term intake of antiepileptic drugs (AEDs). Women are the vulnerable targets owing to post-menopausal bone loss. In the present work, we evaluated the effect of 10 weeks of treatment with AED therapy (carbamazepine, CBZ, 75 mg/kg; sodium valproate, SVP, 300 mg/kg; levetiracetam, LTM, 150 mg/kg) on bone mineral density and microarchitecture at femoral epiphysis, lumbar vertebrae and proximal tibia of normal and ovariectomised Wistar rats. In addition, we measured serum levels of vitamin D, receptor activator of nuclear factor kappa β-ligand (RANKL), procollagen type 1 amino-terminal propeptide (P1NP) and wnt inhibitors (sclerostin and DKK-1) following AED therapy. Micro-computed tomography analysis of bones revealed significant reduction in BMD at femur epiphysis and lumbar vertebrae with all the three AEDs evaluated. At proximal tibia, only CBZ showed a significant decline. The reduction in BMD was more pronounced in ovariectomised rats. AEDs also resulted in alteration of micro-CT parameters. These changes were accompanied by an increased serum RANKL with all AEDs while vitamin D levels were reduced only with CBZ treatment and P1NP levels were reduced with SVP and CBZ. Serum sclerostin levels were elevated following all AEDs in normal and ovariectomised rats except with CBZ in normal rats. However, increase in DKK-1 levels was observed with only LTM. Ovariectomy itself resulted in increased RANKL, sclerostin and DKK-1 and reduced vitamin D and P1NP levels. Significant differences were discernible between normal and ovariectomised rats treated with AEDs in all the parameters. However, while sclerostin increased further upon AEDs treatment, P1NP decreased with SVP and CBZ and serum DKK-1 levels showed a declining trend with all the three AEDs studied. We confirm adverse effects on bone following AEDs in female rats. Further, our results demonstrate for the first time that these effects are more pronounced in ovariectomised rats as compared to normal rats and that this could be related to estrogen deficiency which in turn enhances bone resorption via increased RANKL and reduces bone formation via increased sclerostin and reduced P1NP. Finally, our study demonstrated for the first time that AED treatment displayed changes in the serum levels of wnt inhibitors and hence modulation of wnt inhibitors might be partly involved in their adverse effects on bone.
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Affiliation(s)
- Bushra Parveen
- Pharmaceutical Medicine, Department of Pharmacology, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi 110062, India
| | | | - Moon Jain
- Central Drug Research Institute, Division of Pharmacology, Lucknow 226031, Uttar Pradesh, India
| | - Subhashis Pal
- Central Drug Research Institute, Division of Endocrinology, Lucknow 226031, Uttar Pradesh, India
| | - Naibedya Chattopadhyay
- Central Drug Research Institute, Division of Endocrinology, Lucknow 226031, Uttar Pradesh, India
| | - Manjari Tripathi
- Department of Neurology, Neurosciences Centre, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Divya Vohora
- Pharmaceutical Medicine, Department of Pharmacology, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi 110062, India.
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Saraykar S, John V, Cao B, Hnatow M, Ambrose CG, Rianon N. Association of Selective Serotonin Reuptake Inhibitors and Bone Mineral Density in Elderly Women. J Clin Densitom 2018; 21:193-199. [PMID: 28712980 DOI: 10.1016/j.jocd.2017.05.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2017] [Accepted: 05/08/2017] [Indexed: 11/21/2022]
Abstract
Depression and osteoporosis are 2 common comorbidities in geriatric patients. There are concerns about the deleterious effects of selective serotonin reuptake inhibitor (SSRI) antidepressant use on bone mineral density (BMD). We examined the association between SSRI use and BMD in elderly women (≥65 yr) referred to a geriatric osteoporosis clinic for bone health evaluation. Cross-sectional analyses using the general linear model were performed on data collected retrospectively from August 2010 to April 2015. A total of 250 women were seen during the study period. Of these, 140 women had complete data on BMD measurements: 22 (15.7%) used an SSRI and 118 (84.3%) did not. The 2 groups, SSRI users and SSRI nonusers, did not differ significantly across any of the covariates tested (age, ethnicity, body mass index, and past and present osteoporosis treatment medications). After adjusting for covariates, there was no difference in the BMDs at the femoral neck (p = 0.887) or the spine (p = 0.275) between the 2 groups. Similarly, no difference was seen in the T-scores between SSRI users and nonusers at the femoral neck (p = 0.924) or at the spine level (p = 0.393). Our study did not show an association between SSRI use and BMD among elderly women referred for bone health evaluation. Other studies in the literature have been inconclusive, and therefore, robust longitudinal studies are needed to further assess the interaction between SSRI use and predictors of fracture such as BMD, bone turnover markers, and genes involved in bone turnover. Until then, clinicians should closely monitor the bone health of long-term SSRI users.
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Affiliation(s)
- Smita Saraykar
- Department of Psychiatry and Behavioral Sciences, McGovern Medical School at UTHealth, Houston, TX, USA
| | - Vineeth John
- Department of Psychiatry and Behavioral Sciences, McGovern Medical School at UTHealth, Houston, TX, USA
| | - Bo Cao
- Department of Psychiatry and Behavioral Sciences, McGovern Medical School at UTHealth, Houston, TX, USA
| | - Matthew Hnatow
- Department of Orthopedic Surgery, McGovern Medical School at UTHealth, Houston, TX, USA
| | - Catherine G Ambrose
- Department of Orthopedic Surgery, McGovern Medical School at UTHealth, Houston, TX, USA
| | - Nahid Rianon
- Department of Internal Medicine, McGovern Medical School at UTHealth, Houston, TX, USA.
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Mazziotti G, Formenti AM, Frara S, Olivetti R, Banfi G, Memo M, Maroldi R, Giubbini R, Giustina A. High Prevalence of Radiological Vertebral Fractures in Women on Thyroid-Stimulating Hormone-Suppressive Therapy for Thyroid Carcinoma. J Clin Endocrinol Metab 2018; 103:956-964. [PMID: 29121201 DOI: 10.1210/jc.2017-01986] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Accepted: 11/01/2017] [Indexed: 02/13/2023]
Abstract
CONTEXT Bone loss and nonvertebral fractures have been reported in patients with differentiated thyroid carcinoma (DTC) undergoing thyroid-stimulating hormone (TSH) suppressive therapy. Radiological vertebral fractures (VFs) are an early and clinically crucial marker of bone fragility. OBJECTIVE AND DESIGN A cross-sectional study to evaluate the prevalence and determinants of radiological VFs in women receiving l-thyroxine (L-T4) therapy for DTC. PATIENTS AND INTERVENTIONS A total of 179 consecutive women (median age, 59 years; n = 178 postmenopausal) who had undergone thyroidectomy for DTC and were currently receiving L-T4 were evaluated for radiological VFs and bone mineral density (BMD). There were three TSH target levels [<0.5 mU/L, group 1 (n = 83); 0.5 to 1.0 mU/L, group 2 (n = 50); >1.0 mU/L, group 3 (n = 46)]. RESULTS VFs were found in 51 patients (28.5%), with significantly (P < 0.001) higher prevalence in group 1 (44.6%) as compared with group 2 (24.0%) and group 3 (4.3%). VF prevalence was not significantly different among patients in group 1 with normal BMD, osteopenia, or osteoporosis, whereas in groups 2 and 3, VFs were more frequent in patients with osteoporosis than in those with either osteopenia or normal BMD. In the whole population, VFs were significantly and independently associated with TSH level <1.0 mU/L; densitometric diagnosis of osteoporosis at lumbar spine, femoral neck, or total hip; age of patients; and duration of L-T4 therapy. CONCLUSION The prevalence of VFs was high in women with DTC who were undergoing long-term, suppressive L-T4 therapy.
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Affiliation(s)
| | - Anna Maria Formenti
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Stefano Frara
- Department of Endocrinology, Vita-Salute San Raffaele University, Milan, Italy
| | - Roberto Olivetti
- Endocrine Unit, Azienda Socio-Sanitaria Territoriale, Mantua, Italy
| | - Giuseppe Banfi
- Department of Biochemistry, Vita-Salute San Raffaele University, Milan, Italy
- Laboratory of Experimental Biochemistry and Molecular Biology, I.R.C.C.S. Istituto Ortopedico Galeazzi, Milan, Italy
| | - Maurizio Memo
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Roberto Maroldi
- Department of Radiology, University of Brescia, Brescia, Italy
| | - Raffaele Giubbini
- Department of Nuclear Medicine, University of Brescia, Brescia, Italy
| | - Andrea Giustina
- Department of Endocrinology, Vita-Salute San Raffaele University, Milan, Italy
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Catalano A, Gaudio A, Morabito N, Basile G, Agostino RM, Xourafa A, Atteritano M, Morini E, Natale G, Lasco A. Quantitative ultrasound and DXA measurements in aromatase inhibitor-treated breast cancer women receiving denosumab. J Endocrinol Invest 2017; 40:851-857. [PMID: 28332172 DOI: 10.1007/s40618-016-0606-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2016] [Accepted: 12/27/2016] [Indexed: 01/22/2023]
Abstract
PURPOSE Denosumab has been proven to reduce fracture risk in breast cancer (BC) women under aromatase inhibitors (AIs). Quantitative ultrasound (QUS) provides information on the structure and elastic properties of bone. Our aim was to assess bone health by phalangeal QUS and by dual-energy X-ray absorptiometry (DXA), and to evaluate bone turnover in AIs-treated BC women receiving denosumab. METHODS 35 Postmenopausal BC women on AIs were recruited (mean age 61.2 ± 4.5 years) and treated with denosumab 60 mg administered subcutaneously every 6 months. Phalangeal QUS parameters [Amplitude Dependent Speed of Sound (AD-SoS), Ultrasound Bone Profile Index (UBPI), Bone Transmission Time (BTT)] and DXA at lumbar spine and femoral neck were performed. Serum C-telopeptide of type 1 collagen (CTX) and bone-specific alkaline phosphatase (BSAP) were also measured. The main outcomes were compared with a control group not receiving denosumab (n = 39). RESULTS In patients treated with denosumab, differently from controls, QUS and DXA measurements improved after 24 months, and a reduction of CTX and BSAP was detected at 12 and 24 months in comparison to baseline (P < 0.05). The percent changes (Δ) of QUS measurements were significantly associated with ΔBMD at femoral neck, and ΔCTX and ΔBSAP were associated with ΔBMD at lumbar spine (r = -0.39, P = 0.02; r = -0.49, P = 0.01, respectively). CONCLUSIONS Denosumab preserves bone health as assessed by phalangeal QUS and DXA. Since inexpensive and radiation-free, phalangeal QUS may be considered in the follow-up of AIs-treated BC women receiving denosumab.
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Affiliation(s)
- A Catalano
- Department of Clinical and Experimental Medicine, University Hospital of Messina, University Hospital "G. Martino", Via C. Valeria, 98125, Messina, Italy.
| | - A Gaudio
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - N Morabito
- Department of Clinical and Experimental Medicine, University Hospital of Messina, University Hospital "G. Martino", Via C. Valeria, 98125, Messina, Italy
| | - G Basile
- Department of Clinical and Experimental Medicine, University Hospital of Messina, University Hospital "G. Martino", Via C. Valeria, 98125, Messina, Italy
| | - R M Agostino
- Department of Human Pathology, University of Messina, Messina, Italy
| | - A Xourafa
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - M Atteritano
- Department of Clinical and Experimental Medicine, University Hospital of Messina, University Hospital "G. Martino", Via C. Valeria, 98125, Messina, Italy
| | - E Morini
- Department of Clinical and Experimental Medicine, University Hospital of Messina, University Hospital "G. Martino", Via C. Valeria, 98125, Messina, Italy
| | - G Natale
- Mineral Metabolism and Nephrology Clinic of Vibo Valentia Hospital, Vibo Valentia, Italy
| | - A Lasco
- Department of Clinical and Experimental Medicine, University Hospital of Messina, University Hospital "G. Martino", Via C. Valeria, 98125, Messina, Italy
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Hong AR, Kim JH, Lee KH, Kim TY, Im SA, Kim TY, Moon HG, Han WS, Noh DY, Kim SW, Shin CS. Long-term effect of aromatase inhibitors on bone microarchitecture and macroarchitecture in non-osteoporotic postmenopausal women with breast cancer. Osteoporos Int 2017; 28:1413-1422. [PMID: 28083668 DOI: 10.1007/s00198-016-3899-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Accepted: 12/28/2016] [Indexed: 12/13/2022]
Abstract
UNLABELLED In non-osteoporotic postmenopausal women with breast cancer, aromatase inhibitors (AIs) negatively affected bone mineral density (BMD), lumbar spine trabecular bone score (TBS) as a bone microarchitecture index, and hip geometry as a bone macroarchitecture index. INTRODUCTION AIs increase the risk of fracture in patients with breast cancer. Therefore, we aimed to evaluate the long-term skeletal effects of AIs in postmenopausal women with primary breast cancer. METHODS We performed a retrospective longitudinal observational study in non-osteoporotic patients with breast cancer who were treated with AIs for ≥3 years (T-score >-2.5). Patients with previous anti-osteoporosis treatment or those who were given bisphosphonate during AI treatment were excluded from the analysis. We serially assessed BMD, lumbar spine TBS, and hip geometry using dual-energy X-ray absorptiometry. RESULTS BMD significantly decreased from baseline to 5 years at the lumbar spine (-6.15%), femur neck (-7.12%), and total hip (-6.35%). Lumbar spine TBS also significantly decreased from baseline to 5 years (-2.12%); this change remained significant after adjusting for lumbar spine BMD. The annual loss of lumbar spine BMD and TBS slowed after 3 and 1 year of treatment, respectively, although there was a relatively constant loss of BMD at the femur neck and total hip for up to 4 years. The cross-sectional area, cross-sectional moment of inertia, minimal neck width, femur strength index, and section modulus significantly decreased, although the buckling ratio increased over the treatment period (all P < 0.001); these changes were independent of total hip BMD. CONCLUSIONS Long-term adjuvant AI treatment negatively influenced bone quality in addition to BMD in patients with breast cancer. This study suggests that early monitoring and management are needed in non-osteoporotic patients with breast cancer who are starting AIs.
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Affiliation(s)
- A R Hong
- Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea
| | - J H Kim
- Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea.
| | - K H Lee
- Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea
| | - T Y Kim
- Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea
| | - S A Im
- Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea
| | - T Y Kim
- Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea
| | - H G Moon
- Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - W S Han
- Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - D Y Noh
- Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - S W Kim
- Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea
- Department of Internal Medicine, Seoul Metropolitan Government Boramae Medical Center, Seoul, South Korea
| | - C S Shin
- Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea
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Abstract
Bisphosphonates will become increasingly important in the management of patients with breast cancer. Currently, bisphosphonates are used to treat bone metastasis because they effectively relieve pain, prevent pathological fractures and treat hypercalcaemia of malignancy. Recent advances in systemic adjuvant therapies for breast cancer are improving survival but many treatments are detrimental to bone and can increase the risk of fracture. The monitoring of breast cancer patients at risk of developing osteoporosis will become increasingly important as survival times improve and more potent treatments are developed. Bisphosphonates may also play a role as an adjuvant therapy for the prevention of bone metastasis in high-risk breast cancer patients.
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Affiliation(s)
- James Lester
- Academic Unit of Clinical Oncology, Weston Park Hospital, Sheffield, UK
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Starostzik C. [Brittle bones caused by antidepressants?]. MMW Fortschr Med 2016; 158:20. [PMID: 27271391 DOI: 10.1007/s15006-016-8352-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
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van der Hoorn MMC, Tett SE, de Vries OJ, Dobson AJ, Peeters GMEEG. The effect of dose and type of proton pump inhibitor use on risk of fractures and osteoporosis treatment in older Australian women: A prospective cohort study. Bone 2015; 81:675-682. [PMID: 26319499 DOI: 10.1016/j.bone.2015.08.024] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Revised: 08/24/2015] [Accepted: 08/25/2015] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Proton pump inhibitors (PPIs) are among the most prescribed medications worldwide, however, there is growing concern regarding potential negative effects on bone health. The aim was to examine the effect of dose and type of PPI use on subsequent use of osteoporosis medication and fractures in older Australian women. METHODS Data were included from 4432 participants (born 1921-26) in the 2002 survey of the Australian Longitudinal Study on Women's Health. Medication data were from the national pharmaceutical administrative database (2003-2012, inclusive). Fractures were sourced from linked hospital datasets available for four major States of Australia. Competing risk regression models used PPI exposure as a time-dependent covariate and either time to first osteoporosis medication prescription or fracture as the outcome, with death as a competing risk. RESULTS Of the 2328 PPI users and 2104 PPI non-users, 827 (36%) and 550 (26%) became users of osteoporosis medication, respectively. PPI use was associated with an increased risk of subsequent use of osteoporosis medication (adjusted sub-hazard ratio [SHR]=1.28; 95% confidence interval [CI]=1.13-1.44) and subsequent fracture (SHR=1.29, CI=1.08-1.55). Analysis with PPI categorized according to defined daily dose (DDD), showed some evidence for a dose-response effect (osteoporosis medication: <400 DDD: SHR=1.23, CI=1.06-1.42 and ≥400 DDD: SHR=1.39, CI=1.17-1.65, compared with non-users; SHRs were in the same range for fractures). Esomeprazole was the most common PPI prescribed (22.9%). Analysis by type of PPI use showed an increased subsequent risk for: (1) use of osteoporosis medication for rabeprazole (SHR=1.51, CI=1.08-2.10) and esomeprazole (SHR=1.48, CI=1.17-1.88); and (2) fractures for rabeprazole (SHR=2.06, CI=1.37-3.10). Users of multiple types of PPI also had increased risks for use of osteoporosis medication and fractures. CONCLUSION An appropriate benefit/risk assessment should be made when prescribing PPIs, especially for esomeprazole and rabeprazole, as osteoporosis and fracture risks were increased in this cohort of elderly females subsequent to PPI prescription.
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Affiliation(s)
- Mariëlle M C van der Hoorn
- The University of Queensland, School of Public Health, Brisbane, QLD 4006, Australia; VU University Amsterdam, Faculty of Medicine, Amsterdam 1081 BT, Netherlands
| | - Susan E Tett
- The University of Queensland, School of Pharmacy, Brisbane, QLD 4072, Australia
| | - Oscar J de Vries
- VU University Medical Center, Department of Internal Medicine, Amsterdam 1007 MB, Netherlands
| | - Annette J Dobson
- The University of Queensland, School of Public Health, Brisbane, QLD 4006, Australia
| | - G M E E Geeske Peeters
- The University of Queensland, School of Public Health, Brisbane, QLD 4006, Australia; The University of Queensland, School of Human Movement and Nutrition Sciences, Brisbane, QLD 4072, Australia.
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Cepa M, Vaz C. Management of bone loss in postmenopausal breast cancer patients treated with aromatase inhibitors. Acta Reumatol Port 2015; 40:323-330. [PMID: 26922195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Breast cancer is the most commonly diagnosed cancer among women, but despite survival rates improvement, it is still the second major cause of cancer related death. In postmenopausal women with estrogen receptor (ER) dependent breast cancer, hormone therapy is an option, either by direct inhibition of ER using tamoxifen or by aromatase inhibition, resulting in decreased estrogen production. In this paper these two endocrine therapy approaches are compared in terms of their impact on bone health. Guidance for the prevention of bone loss and occurrence of fractures in postmenopausal women receiving AIs is also proposed. Despite intervention strategies to maintain bone health in AI-treated patients are not well established, recommendations by international societies to identify women with high risk of fracture and advice on the preventive anti-fracture therapy are exposed. Finally, available therapeutic options for management of bone loss in patients receiving AIs are presented. The search strategy for this literature review was conducted by using the key words "aromatase inhibitor*" and "bone loss" OR "aromatase inhibitor*" and "osteoporosis" in the MEDLINE/PubMed database. Nowadays, hormone-responsive breast cancer in postmenopausal women is preferably being treated with AIs instead of tamoxifen, due to clear benefits in disease-free survival and reduced recurrence. AIs have an advantageous side effect profile compared to tamoxifen, however all AIs have detrimental long-term effects on bone, due to nearly complete depletion of estrogens, resulting in increased bone loss and increased risk of fracture. Current recommendations state that all women treated with AIs should be evaluated for their fracture risk prior to initiation of AI-treatment, taking in consideration individual bone mineral density and several risk factors. The thresholds to introduce preventive therapy and drugs proposed differ among the available recommendations. Lifestyle modifications and adequate calcium and vitamin D supplementation have been documented to have good impact in long-term bone health. Additionally, bisphosphonates are the first therapeutic option for AI induced bone loss and should be continued as long as AI-treatment is maintained, being iv zoledronic acid 4 mg every 6 months the best tolerated option.
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Singapore Cancer Network (SCAN) Breast Cancer Workgroup. Singapore Cancer Network (SCAN) Guidelines for Bisphosphonate Use in the Adjuvant Breast Cancer Setting. Ann Acad Med Singap 2015; 44:368-78. [PMID: 26763054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
INTRODUCTION The SCAN breast cancer workgroup aimed to develop Singapore Cancer Network (SCAN) clinical practice guidelines regarding the optimal time-point for initiation of bisphosphonates when using adjuvant aromatase inhibitors (AIs) and provide a consensus for their role in modifying clinical breast cancer outcomes. MATERIALS AND METHODS The workgroup utilised a modified ADAPTE process to calibrate high quality international evidence-based clinical practice guidelines to our local setting. RESULTS Six international guidelines were evaluated-those developed by the National Cancer Comprehensive Network (2015), the European Society of Medical Oncology (2014), the National Institute for Clinical Evidence (2012), the Scottish Intercollegiate Guidelines Network (2013), the British Columbia Cancer Agency (2013) and the treatment algorithm based on the National Osteoporosis Foundation guidelines (2006). Recommendations on the use of bisphosphonates in postmenopausal women initiating adjuvant AIs in breast cancer to preserve bone health and the use of adjuvant bisphosphonates to improve breast cancer outcomes were developed. CONCLUSION These adapted guidelines form the SCAN Guidelines on the use of adjuvant bisphosphonates to influence breast cancer outcomes and maintenance of bone health when on AIs.
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Andreasen CM, Ding M, Overgaard S, Bollen P, Andersen TL. A reversal phase arrest uncoupling the bone formation and resorption contributes to the bone loss in glucocorticoid treated ovariectomised aged sheep. Bone 2015; 75:32-9. [PMID: 25689083 DOI: 10.1016/j.bone.2015.02.014] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Accepted: 02/09/2015] [Indexed: 01/08/2023]
Abstract
Large animals as sheep are often used as models for human osteoporosis. Our aim was therefore to determine how glucocorticoid treatment of ovariectomised sheep affects the cancellous bone, determining the cellular events within the bone remodelling process that contributes to their bone loss. Twenty female sheep were assigned for two groups; an untreated control group and an ovariectomised group treated with glucocorticoids (0.6 mg/kg/day, 5 times weekly) for 7 months. At 7 months the glucocorticoid-treated ovariectomised sheep showed a significant change in the bone microstructure revealed by a decreased trabecular bone volume and thickness compared to the control sheep. The treatment led to a temporary elevation of the bone resorption marker CTX (c-terminal collagen telopeptide), while the bone formation marker osteocalcin remained suppressed all 7 months. Histomorphometrically, the treated sheep had a complete absence of osteoid surfaces, and a 5-fold increase in the extent of eroded/reversal surfaces after 7 months. Most of these reversal surfaces were actually arrested reversal surfaces, defined as reversal surfaces without the presence of neighbouring osteoid surfaces or osteoclasts, which is classically observed next to active reversal surfaces. As in humans, these arrested reversal surfaces had compared to active reversal surfaces a reduced canopy coverage, a significantly decreased cell density, and a decreased immunoreactivity for the osteoblastic markers osterix, runx2 and smooth muscle actin in the mononuclear reversal cells colonising the surfaces. In conclusion, glucocorticoid treatment of ovariectomised sheep induced a significant bone loss, caused by an arrest of the reversal phase, resulting in an uncoupling of the bone formation and resorption during the reversal phase, as recently demonstrated in postmenopausal women with glucocorticoid-induced osteoporosis. This supports the relevance of the sheep model to the pathophysiology of glucocorticoid-induced osteoporosis in postmenopausal women, making it a relevant preclinical model for orthopaedic implant and biomaterial research.
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Affiliation(s)
- Christina M Andreasen
- Orthopaedic Research Laboratory, Department of Orthopaedics and Traumatology O, Odense University Hospital, Institute of Clinical Research, University of Southern Denmark, J. B. Winsloewsvej 15 ground floor, DK-5000 Odense C, Denmark.
| | - Ming Ding
- Orthopaedic Research Laboratory, Department of Orthopaedics and Traumatology O, Odense University Hospital, Institute of Clinical Research, University of Southern Denmark, J. B. Winsloewsvej 15 ground floor, DK-5000 Odense C, Denmark.
| | - Søren Overgaard
- Orthopaedic Research Laboratory, Department of Orthopaedics and Traumatology O, Odense University Hospital, Institute of Clinical Research, University of Southern Denmark, J. B. Winsloewsvej 15 ground floor, DK-5000 Odense C, Denmark.
| | - Peter Bollen
- Biomedical Laboratory, University of Southern Denmark, J. B. Winsloewsvej 23, DK-5000 Odense C, Denmark.
| | - Thomas L Andersen
- Department of Clinical Cell Biology (KCB), Vejle Hospital - Lillebaelt Hospital, Institute of Regional Health Research, University of Southern Denmark, Vejle, Kabbeltoft 25, DK-7100 Vejle, Denmark.
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Abstract
UNLABELLED We propose that trabecular bone score could be a useful tool for the study of glucocorticoid-associated bone effects. Trabecular bone score alone and lumbar spine bone mineral density (BMD) used in combination with trabecular bone score, but not lumbar spine BMD alone was able to discriminate between glucocorticoid-treated and glucocorticoid-naïve women. INTRODUCTION Glucocorticoids result in rapid bone loss and an increase in fracture risk that cannot be fully explained by changes in BMD. Trabecular bone score (TBS) correlates with three-dimensional bone micro-architectural parameters and can be derived from grey-level variations within dual energy X-ray absorptiometry (DXA) scans. We propose that TBS could be a useful tool for the study of glucocorticoid-associated bone effects. METHODS We assessed the ability of lumbar spine BMD (LS-BMD), TBS, and LS-BMD with TBS (LS-BMD + TBS) to discriminate between healthy women and (i) glucocorticoid-treated women, and (ii) glucocorticoid-naïve women with recent fractures. Older women (n = 484, ages 55-79 years) who had (i) taken prednisolone ≥5 mg/day for >3 months (n = 64), (ii) sustained a recent fracture of the distal forearm (n = 46), proximal humerus (n = 37), vertebra (n = 30) or proximal femur (n = 28), or (iii) were healthy population-based women (n = 279) were recruited. LS-BMD was measured by DXA and TBS values were derived. RESULTS Compared to healthy, population-based women, women with recent fractures had lower LS-BMD (-0.34 to -1.38) and TBS (-0.38 to -1.04) Z-scores. Glucocorticoid-treated women had lower TBS Z-scores than glucocorticoid-naïve women (-0.80 versus 0) but their LS-BMD Z-scores did not differ (-0.13 versus 0). TBS alone (area under the receiver operating characteristic curve (AUC) = 0.721) and LS-BMD + TBS (AUC = 0.721), but not LS-BMD alone (AUC = 0.572) was able to discriminate between glucocorticoid-treated and glucocorticoid-naïve women. CONCLUSIONS TBS provides additional information regarding glucocorticoid-associated alterations in bone quality. We conclude that TBS may be a useful tool for the further study of glucocorticoid-induced osteoporosis.
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Affiliation(s)
- M A Paggiosi
- Academic Unit of Bone Metabolism (AUBM), The University of Sheffield, Sheffield, UK.
| | - N F A Peel
- Sheffield Teaching Hospitals NHS Foundation Trust, Northern General Hospital, Sheffield, UK
| | - R Eastell
- Academic Unit of Bone Metabolism (AUBM), The University of Sheffield, Sheffield, UK
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Greenspan SL, Vujevich KT, Brufsky A, Lembersky BC, van Londen GJ, Jankowitz RC, Puhalla SL, Rastogi P, Perera S. Prevention of bone loss with risedronate in breast cancer survivors: a randomized, controlled clinical trial. Osteoporos Int 2015; 26:1857-64. [PMID: 25792492 PMCID: PMC4766869 DOI: 10.1007/s00198-015-3100-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Accepted: 03/03/2015] [Indexed: 10/23/2022]
Abstract
UNLABELLED In postmenopausal women with low bone mass and hormone-receptor-positive breast cancer on an aromatase inhibitor, risedronate maintained skeletal health assessed by bone density and turnover markers. Women with the greatest decreases in bone turnover markers at 12 months had the greatest increases in bone density at 24 months. INTRODUCTION Aromatase inhibitors (AIs), adjuvant endocrine therapy for postmenopausal women with hormone-receptor-positive breast cancer, are associated with bone loss and fractures. Our objectives were to determine if (1) oral bisphosphonate therapy can prevent bone loss in women on an AI and (2) early changes in bone turnover markers (BTM) can predict later changes in bone mineral density (BMD). METHODS We conducted a 2-year double-blind, placebo-controlled, randomized trial in 109 postmenopausal women with low bone mass on an AI (anastrozole, letrozole, or exemestane) for hormone-receptor-positive breast cancer. Participants were randomized to once weekly risedronate 35 mg or placebo, and all received calcium plus vitamin D. The main outcome measures included BMD, BTM [carboxy-terminal collagen crosslinks (CTX) and N-terminal propeptide of type 1 procollagen (P1NP)], and safety. RESULTS Eighty-seven percent completed 24 months. BMD increased more in the active treatment group compared to placebo with an adjusted difference at 24 months of 3.9 ± 0.7 percentage points at the spine and 3.2 ± 0.5 percentage points at the hip (both p < 0.05). The adjusted difference between the active treatment and placebo groups were 0.09 ± 0.04 nmol/LBCE for CTX and 23.3 ± 4.8 μg/mL for P1NP (both p < 0.05). Women with greater 12-month decreases in CTX and P1NP in the active treatment group had a greater 24-month increase in spinal BMD (p < 0.05). The oral therapy was safe and well tolerated. CONCLUSION In postmenopausal women with low bone mass and breast cancer on an AI, the oral bisphosphonate risedronate maintained skeletal health.
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Affiliation(s)
- S L Greenspan
- Department of Medicine, University of Pittsburgh, 3471 Fifth Ave., Suite 1110, Kaufmann Bldg, Pittsburgh, PA, 15213, USA.
| | - K T Vujevich
- Department of Medicine, University of Pittsburgh, 3471 Fifth Ave., Suite 1110, Kaufmann Bldg, Pittsburgh, PA, 15213, USA
| | - A Brufsky
- Department of Medicine, University of Pittsburgh, 3471 Fifth Ave., Suite 1110, Kaufmann Bldg, Pittsburgh, PA, 15213, USA
| | - B C Lembersky
- Department of Medicine, University of Pittsburgh, 3471 Fifth Ave., Suite 1110, Kaufmann Bldg, Pittsburgh, PA, 15213, USA
| | - G J van Londen
- Department of Medicine, University of Pittsburgh, 3471 Fifth Ave., Suite 1110, Kaufmann Bldg, Pittsburgh, PA, 15213, USA
| | - R C Jankowitz
- Department of Medicine, University of Pittsburgh, 3471 Fifth Ave., Suite 1110, Kaufmann Bldg, Pittsburgh, PA, 15213, USA
| | - S L Puhalla
- Department of Medicine, University of Pittsburgh, 3471 Fifth Ave., Suite 1110, Kaufmann Bldg, Pittsburgh, PA, 15213, USA
| | - P Rastogi
- Department of Medicine, University of Pittsburgh, 3471 Fifth Ave., Suite 1110, Kaufmann Bldg, Pittsburgh, PA, 15213, USA
| | - S Perera
- Department of Medicine, University of Pittsburgh, 3471 Fifth Ave., Suite 1110, Kaufmann Bldg, Pittsburgh, PA, 15213, USA
- Department of Biostatistics, University of Pittsburgh, Pittsburgh, PA, USA
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Overman RA, Gourlay ML, Deal CL, Farley JF, Brookhart MA, Layton JB. Fracture rate associated with quality metric-based anti-osteoporosis treatment in glucocorticoid-induced osteoporosis. Osteoporos Int 2015; 26:1515-24. [PMID: 25600474 PMCID: PMC4401629 DOI: 10.1007/s00198-014-3022-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Accepted: 12/26/2014] [Indexed: 01/29/2023]
Abstract
UNLABELLED Anti-osteoporosis medication (AOM) use in patients exposed to glucocorticoids is thought to reduce fractures. We found post-menopausal women using glucocorticoids for at least 90 days who also used an AOM within 90 days had 48 % fewer fractures by 1 year and 32 % fewer fractures by 3 years compared to non-AOM users. INTRODUCTION The purpose of this study is to explore the effectiveness of adherence to quality measures by estimating the effect of anti-osteoporosis medication (AOM) initiation within 90 days after chronic (≥90 days) glucocorticoid (GC) therapy on osteoporotic fracture. METHODS A new-user cohort was assembled using the MarketScan databases between 2000 and 2012. Included patients were female, age ≥50 at GC initiation, had a first GC fill daily dose ≥10 mg and persisted for at least 90 days. During a 365-day baseline period, patients were excluded for prior GC or AOM (bisphosphonate, denosumab, teriparatide) use, fracture, or cancer diagnosis. Initiators of an AOM in the 14 days pre- or 90 days post-GC fill were characterized as AOM users; those without, AOM non-users. Follow-up began 91 days after GC fill with patients followed until fracture, loss of continuous enrollment, initiation of AOM by AOM non-users, or end of study period. A propensity score was estimated for AOM receipt using all measured covariates and converted to a stabilized inverse probability of treatment weights (IPTW). Weighted hazard ratios (HR) and associated 95% confidence intervals (95% CI) were estimated using weighted Cox proportional hazard models. RESULTS Of the 7885 women eligible for the study, 12.1% were AOM users. AOM use was associated with lower fracture incidence: weighted HR of 0.52 (95% CI 0.29, 0.94) at 1 year and weighted HR of 0.68 (95% CI 0.47, 0.99) at 3 years. CONCLUSIONS AOM initiation within 90 days of chronic GC use was associated with a fracture reduction of 48% at 1 year and 32% at 3 years.
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Affiliation(s)
- R A Overman
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Campus Box 7573, Chapel Hill, NC, 27599-7573, USA,
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Ak E, Bulut SD, Bulut S, Akdağ HA, Öter GB, Kaya H, Kaya OB, Şengül CB, Kısa C. Evaluation of the effect of selective serotonin reuptake inhibitors on bone mineral density: an observational cross-sectional study. Osteoporos Int 2015; 26:273-9. [PMID: 25187118 PMCID: PMC4286623 DOI: 10.1007/s00198-014-2859-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Accepted: 08/13/2014] [Indexed: 12/21/2022]
Abstract
UNLABELLED Sixty patients diagnosed with generalized anxiety disorder and treated with either paroxetine, sertraline, or citalopram for at least 12 months were enrolled in this study, and the bone mineral density (BMD) of the patients was compared with that of 40 healthy volunteers. Selective serotonin reuptake inhibitor (SSRI) therapy in generalized anxiety disorder was found to be related with decreased BMD values. INTRODUCTION The objectives of this study were to evaluate the effect of SSRI therapy on BMD in postmenopausal women diagnosed with generalized anxiety disorder (GAD) and to identify the effects of the duration of disease and treatment on risk factors for osteoporosis. METHODS Sixty patients diagnosed with GAD and treated with paroxetine, sertraline, or citalopram from the SSRI group for at least 12 months were enrolled. Social demographic features, the Hamilton Anxiety Scale (HAS) results, and the Hamilton Depression Scale (HDS) scores of all the patients were assessed. The BMD of the patients was measured by dual-energy X-ray absorptiometry (DXA) at the femoral and lumbar regions. The patients were divided into three groups which are the paroxetine, sertraline, and citalopram groups. The BMD of the patients was compared with that of 40 healthy volunteers. RESULTS The L2-L4, total lumbar vertebrae, femoral intertrochanteric, total femoral Z-scores, and femoral Ward's region T-scores of the treatment group were lower than the median T- and Z-scores of the control group (p < 0.05). Of the treatment groups, the femoral neck, trochanteric and intertrochanteric T- and Z-scores, total femoral T- and Z-scores, and femoral Ward's T- and Z-scores of the sertraline group were significantly lower than the BMD values measured at the identical regions in the paroxetine and citalopram groups (p < 0.05).There was a significant negative correlation between the duration of treatment and the BMD values. CONCLUSION SSRI therapy in GAD was found to be related with decreased BMD values. Further randomized controlled studies are warranted to determine whether SSRI use is a risk factor for osteoporosis; such studies should investigate these factors by performing BMD assessments before treatment.
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Affiliation(s)
- E. Ak
- Psychiatry Department, Medical Park Gaziantep Hospital, Gaziantep, Turkey
| | - S. D. Bulut
- Psychiatry Department, Dışkapı Yıldırım Beyazıt Educational and Traditional Hospital, Ankara, Turkey
| | - S. Bulut
- Psychiatry Department, Gülhane Military Medical Academy, Ankara, Turkey
| | - H. A. Akdağ
- Psychiatry Department, Bursa State Hospital, Bursa, Turkey
| | - G. B. Öter
- Psychiatry Department, Ankara Numune Educational and Traditional Hospital, Ankara, Turkey
| | - H. Kaya
- Psychiatry Department, 25 Aralık State Hospital, Gaziantep, Turkey
| | - O. B. Kaya
- Psychiatry Department, Dr. Ersin Arslan State Hospital, Gaziantep, Turkey
| | - C. B. Şengül
- Faculty of Medicine, Psychiatry Department, Pamukkale University, Denizli, Turkey
| | - C. Kısa
- Psychiatry Department, Dışkapı Yıldırım Beyazıt Educational and Traditional Hospital, Ankara, Turkey
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Silverman S, Curtis J, Saag K, Flahive J, Adachi J, Anderson F, Chapurlat R, Cooper C, Diez-Perez A, Greenspan S, Hooven F, Le Croix A, March L, Netelenbos JC, Nieves J, Pfeilschifter J, Rossini M, Roux C, Siris E, Watts N, Compston J. International management of bone health in glucocorticoid-exposed individuals in the observational GLOW study. Osteoporos Int 2015; 26:419-20. [PMID: 25257932 PMCID: PMC4873770 DOI: 10.1007/s00198-014-2883-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Accepted: 08/28/2014] [Indexed: 11/30/2022]
Affiliation(s)
- S Silverman
- Division of Rheumatology, Cedars-Sinai Medical Center, Los Angeles, CA, USA,
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Sutter S, Nishiyama KK, Kepley A, Zhou B, Wang J, McMahon DJ, Guo XE, Stein EM. Abnormalities in cortical bone, trabecular plates, and stiffness in postmenopausal women treated with glucocorticoids. J Clin Endocrinol Metab 2014; 99:4231-40. [PMID: 25127089 PMCID: PMC4223438 DOI: 10.1210/jc.2014-2177] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT The mechanisms by which glucocorticoids (GCs) increase skeletal fragility are not well understood. OBJECTIVE The objective of the study was to evaluate the microarchitecture, trabecular morphology, and biomechanical properties of bone in postmenopausal women treated with GCs. DESIGN This was a case-control study. SETTING The study was conducted at a university hospital outpatient facility. PATIENTS Postmenopausal women treated with oral GCs for longer than 3 months (n = 30) and age/race-matched controls (n = 60) participated in the study. MAIN OUTCOME MEASURES Areal bone mineral density aBMD (BMD) by dual-energy x-ray absorptiometry (DXA) was measured. Trabecular and cortical volumetric BMD (vBMD) and microarchitecture by high-resolution peripheral computed tomography of the distal radius and tibia were also measured. Whole-bone stiffness was estimated by finite element analysis. A novel technique, individual trabecula segmentation, was used to evaluate trabecular type (as plate or rod), orientation, and connectivity. RESULTS DXA T-scores did not differ significantly at any site. GC subjects had significantly lower total, cortical, and trabecular vBMD and thinner cortices, fewer, thinner, more widely, and irregularly spaced trabeculae. They had fewer trabecular plates, fewer axially aligned trabeculae, and lower trabecular connectivity. Differences ranged from 4% to 65% for these trabecular measures and 5% to 17% for the cortical measures. Whole-bone stiffness was significantly lower (11%-16%) in GC subjects. Markers of bone formation (osteocalcin and amino-terminal propeptide of type I procollagen) and resorption (C-telopeptide) were lower in the GC subjects. CONCLUSIONS Despite similar areal BMD by DXA, GC-treated women had abnormal cortical and trabecular vBMD and microarchitecture at both the radius and tibia, including fewer trabecular plates, a less axially aligned trabecular network, lower trabecular connectivity, thinner cortices, and lower whole-bone stiffness. Further research into these abnormalities as mechanisms for fracture in GC-treated women is warranted.
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Affiliation(s)
- Stephanie Sutter
- Department of Medicine (S.S., K.K.N., A.K., D.J.M., E.M.S.), Columbia University College of Physicians and Surgeons, New York, New York 10032; and Bone Bioengineering Laboratory (B.Z., J.W., X.E.G.), Department of Biomedical Engineering, Columbia University, New York, New York 10027
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Fitzpatrick LA, Wooddell M, Dabrowski CE, Cicconetti G, Gordon DN. Bone mineral density changes following discontinuation of ronacaleret treatment: off-treatment extension of a randomized, dose-finding phase II trial. Bone 2014; 67:104-8. [PMID: 24794093 DOI: 10.1016/j.bone.2014.04.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Revised: 04/21/2014] [Accepted: 04/22/2014] [Indexed: 10/25/2022]
Abstract
CONTEXT Parathyroidectomy in patients with hyperparathyroidism can produce subsequent increases in bone mineral density (BMD). Ronacaleret, a selective calcium-sensing receptor antagonist that stimulates endogenous parathyroid hormone release, induced mild hyperparathyroidism. OBJECTIVE The aim of this study is to evaluate whether BMD changes after cessation of ronacaleret treatment. DESIGN Observational, off-treatment, extension of a randomized, placebo-controlled, dose-ranging phase II trial. SETTING Fifteen academic centers in seven countries. PATIENTS Postmenopausal women with low BMD; 171 out of 569 women in the parent study were enrolled in the extension study. INTERVENTIONS Subjects were treated with ronacaleret 100mg (n=16), 200mg (n=38), 300mg (n=35), or 400mg (n=32) once daily, alendronate 70mg (n=17) once weekly, or matching placebo (n=33) for 10-12months; BMD was measured after discontinuation of ronacaleret or alendronate treatment. MAIN OUTCOME MEASURE Mean percent change in lumbar spine areal BMD by dual-energy X-ray absorptiometry at 6-12months after discontinuing ronacaleret or alendronate compared with the 10- to 12-month BMD measurement of the parent study. RESULTS At the lumbar spine, all doses of ronacaleret resulted in gains in BMD while on treatment. These increases in BMD were maintained or increased after discontinuation of ronacaleret. All doses of ronacaleret caused bone loss at the total hip while on active treatment. However, there was an attenuation of this loss in the off-treatment extension study. CONCLUSION The gain in BMD at the lumbar spine was maintained post-treatment and the loss of BMD at the total hip was attenuated. We hypothesize that there may have been some bone remineralization after cessation of ronacaleret.
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Diem SJ, Joffe H, Larson JC, Tsai JN, Guthrie KA, LaCroix AZ, Ensrud KE, Freeman EW, Leder BZ. Effects of escitalopram on markers of bone turnover: a randomized clinical trial. J Clin Endocrinol Metab 2014; 99:E1732-7. [PMID: 25014001 PMCID: PMC4154080 DOI: 10.1210/jc.2014-2288] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Recent observational studies have suggested that the use of selective serotonin reuptake inhibitors is associated with an increased fracture risk and an accelerated bone loss, although conflicting results have been reported. Furthermore, because many of these studies have been performed in depressed women, confounding by indication may influence these findings. OBJECTIVE The objective of the study was to determine whether selective serotonin reuptake inhibitors affect bone metabolism Design: This was a randomized controlled trial. SETTING The study was conducted in four US clinical sites. PARTICIPANTS Healthy peri- and postmenopausal women participated in the study. INTERVENTION The intervention was escitalopram (10-20 mg/d) for the treatment of vasomotor symptoms. MAIN OUTCOME MEASURES Serum carboxyterminal collagen crosslinks (CTX) and serum amino-terminal propeptide of type I collagen (P1NP) were measured. RESULTS One hundred forty-one peri- or postmenopausal nondepressed women (mean age 53.7 y, SD 4.1) had baseline and 8-week follow-up samples available for analysis and were included in the study (69 escitalopram, 72 placebo). The groups were balanced across a broad range of baseline characteristics, including age, race, body mass index, smoking status, and mood symptoms. The between-group differences in the change in CTX and P1NP from baseline to week 8 were compared by a repeated-measures linear regression model adjusted for race, clinical center, and baseline measurement. Treatment with escitalopram reduced serum P1NP by 1.02 ng/mL on average [95% confidence interval (CI) -5.17, 3.12] compared with a reduction of 1.88 ng/mL (95% CI -4.82, 1.06) in the placebo group (P = .65). Similarly, serum CTX decreased 0.02 ng/mL on average (95% CI -0.05, 0.01) in the escitalopram group compared with 0.00 ng/mL (95% CI -0.02, 0.02) in the placebo group (P = .24). The results were similar when the analysis was restricted to those women whose adherence to study medication was 70% or greater. CONCLUSIONS Although the study was limited to 8 weeks, these results suggest that escitalopram does not significantly alter bone metabolism in the short term.
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Affiliation(s)
- Susan J Diem
- University of Minnesota (S.J.D., K.E.E.), Minneapolis, Minnesota 55415; Brigham and Women's Hospital and Dana Farber Cancer Institute (H.J.), Boston, Massachusetts 02115; Fred Hutchinson Cancer Research Center (J.C.L., A.Z.L.), Seattle, Washington 98109; Massachusetts General Hospital (J.N.T., B.Z.L.), Boston, Massachusetts 02114; Minneapolis Veterans Affairs Health Care System (K.E.E.), Minneapolis, Minnesota 55417; and Perelman School of Medicine (E.W.F.), University of Pennsylvania, Philadelphia, Pennsylvania 19104
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Li YQ, Sun H, Xue D, Xu YC, Li ZD, Wang W, Li PP. [Prevention and treatment of aromatase inhibitor-associated bone loss by shugan jiangu recipe in postmenopausal women with breast cancer: a clinical study]. Zhongguo Zhong Xi Yi Jie He Za Zhi 2014; 34:1064-1068. [PMID: 25335329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To study the effect of Shugan Jiangu Recipe (SJR) on bone mineral density (BMD) and serum bone metabolic biochemical markers in postmenopausal breast cancer patients with osteopenia. METHODS Totally 38 patients of postmenopausal women with breast cancer, who received aromatase inhibitors (AIs), were assigned to the treatment group (21 cases) and the control group (17 cases) by using random digit table. All patients took Caltrate D Tablet (containing Ca 600 mg and Vit D3 125 IU), one tablet daily. Patients in the treatment group took SJR, 6 g each time, twice daily for 6 successive months. The bone mineral density (BMD) level was detected before treatment and at months 6 after treatment. Levels of bone alkaline phosphatase (BALP), bone gla protein (BGP), tartrate-resistant acid phosphatase (TRAP), and C-terminal telopeptide of type II collagen (CTX-II) were detected by enzyme linked immunosorbent assay (ELISA). The drug safety was also assessed. RESULTS Compared with before treatment, BMD of L2-4 and femur neck obviously increased in the treatment group at month 6 after treatment (P < 0.01), serum BALP and TRAP decreased (P < 0.05). Compared with before treatment, BMD of L2-4 and femur neck obviously decreased in the control group at month 6 after treatment (P < 0.05), serum BALP and TRAP increased (P < 0.01). Compared with the control group, lumbar and femur neck BMD obviously increased, serum levels of BGP and BALP obviously decreased, and serum levels of CTX-II and TRAP obviously increased in the treatment group at month 6 after treatment (P < 0.01). No serious adverse event occurred during the treatment period. Bone fracture occurred in one case of the control group (5.8%). CONCLUSION SJR could attenuate bone loss of postmenopausal women with breast cancer who received AIs, increase BMD and improve abnormal bone metabolism.
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Xiu Bing-He; Consensus Expert Group For Prevention Diagnosis And Treatment Of Bone Loss And Osteoporosis In Postmenopausal Breast Cancer Patients After Aromatase Inhibitor Therapy. [Expert group consensus: prevention, diagnosis and treatment of bone loss and osteoporosis in postmenopausal breast cancer patients after aromatase inhibitor therapy]. Zhonghua Zhong Liu Za Zhi 2013; 35:876-9. [PMID: 24447490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Villa P, Moruzzi MC, Lassandro AP, Leoni F, Di Nardo F, De Waure C, Scambia G. Glucocorticoid therapy as a significant risk factor for osteoporosis and fractures in an Italian postmenopausal population. Gynecol Endocrinol 2013; 29:678-82. [PMID: 23638623 DOI: 10.3109/09513590.2013.788631] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
OBJECTIVE To analyze the potential effects of glucocorticoid treatment without an osteoporosis prevention strategy and to precociously identify patients at high risk of osteoporosis and fragility fractures in the postmenopausal period. METHODS A total of 382 postmenopausal patients, 177 exposed and 205 not exposed to glucocorticoid therapy, were studied using a standard questionnaire. Epidemiological as well as clinical data that included the most recent absorptiometry test results were examined. RESULTS Osteoporosis and fractures were frequent in the postmenopausal glucocorticoid-treated patients. Fragility fractures occurred more frequently in glucocorticoid-treated patients (vertebral fractures represented 45% of all fractures) than in the non-glucocorticoid-treated patients. In particular, the highest fracture percentage was found in 50- to 65-year-old glucocorticoid-treated patients, a subset of patients showing a prevalence of osteoporosis similar to that of non-exposed menopausal subjects older than 65. Glucocorticoid therapy increases the risk of fragility fractures fivefold and doubles the risk of osteoporosis in menopausal patients. CONCLUSIONS Glucocorticoid treatments put menopausal patients at a high risk of incurring fragility fractures even in the early postmenopausal period. The management of strategies for fracture prevention must take into consideration early intervention in patients undergoing or about to undergo glucocorticoid treatment.
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Affiliation(s)
- Paola Villa
- Department of Obstetrics and Gynaecology, Catholic University of Sacred Heart, Rome, Italy.
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Abstract
Aromatase Inhibitors are anti-estrogen agents that have proven efficacy for adjuvant therapy of estrogen receptor positive breast cancer primarily in post menopausal women with estrogen receptor positive breast cancer but increase the risk of cancer therapy induced bone loss (CTIBL). Recent studies have shown the potential benefit of bisphosphonate therapy to play a dual role in the management of breast cancer. These studies provide evidence that bisphosphonate therapy in conjunction with aromatase inhibitors (AI), not only decreases the risk of osteoporosis but, in addition, may improve survival from breast cancer.
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Affiliation(s)
- Renee Z Rinaldi
- Cedars Sinai Medical Center, The David Geffen School of Medicine, UCLA, 150 North Robertson Blvd, Beverly Hills, CA 90211, USA.
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Thomas T, Horlait S, Ringe JD, Abelson A, Gold DT, Atlan P, Lange JL. Oral bisphosphonates reduce the risk of clinical fractures in glucocorticoid-induced osteoporosis in clinical practice. Osteoporos Int 2013; 24:263-9. [PMID: 22736069 DOI: 10.1007/s00198-012-2060-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2012] [Accepted: 06/05/2012] [Indexed: 01/22/2023]
Abstract
UNLABELLED This study aims to estimate bisphosphonate effectiveness by comparing fracture incidence over time on therapy in glucocorticoid-induced osteoporosis (GIO). From this observational study, alendronate and risedronate decreased clinical vertebral and nonvertebral fractures over time. The effectiveness of each bisphosphonate is consistent with their efficacies demonstrated on surrogate markers in randomized controlled trials (RCTs). INTRODUCTION This study aims to estimate bisphosphonate effectiveness by comparing fracture incidence over time on therapy with fracture incidence during a short period after starting a therapy. METHODS The study population was a subgroup of a larger cohort study comprising two cohorts of women aged ≥65 years, prescribed with alendronate or risedronate. Within the two study cohorts, 11,007 women were identified as having received glucocorticoids. Within each cohort, the baseline incidence of clinical fractures at nonvertebral and vertebral sites was defined by the initial 3-month period after starting therapy. Relative to these baseline data, we then compared the fracture incidence during the subsequent 12 months on therapy. RESULTS The baseline incidence of clinical nonvertebral and vertebral fractures was similar in the alendronate cohort (5.22 and 5.79/100 person-years, respectively) and in the risedronate cohort (5.51 and 5.68/100 person-years, respectively). Relative to the baseline incidence, fracture incidence was significantly lower in the subsequent 12 months in both cohorts of alendronate (33 % lower at nonvertebral sites and 59 % at vertebral sites) and risedronate (28 % lower at nonvertebral sites and 54 % at vertebral sites). CONCLUSION From this observational study not designed to compare drugs, both alendronate and risedronate decreased clinical vertebral and nonvertebral fractures over time. The reductions observed in fracture incidence, within each cohort, suggest that the effectiveness of each bisphosphonate in clinical practice is consistent with their efficacies demonstrated on surrogate markers in randomized controlled trials.
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Affiliation(s)
- T Thomas
- INSERM U1059, Rheumatology Department, University Hospital of Saint-Etienne, 42055, Saint-Etienne Cedex 2, France.
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Mercer KE, Wynne RA, Lazarenko OP, Lumpkin CK, Hogue WR, Suva LJ, Chen JR, Mason AZ, Badger TM, Ronis MJJ. Vitamin D supplementation protects against bone loss associated with chronic alcohol administration in female mice. J Pharmacol Exp Ther 2012; 343:401-12. [PMID: 22892342 PMCID: PMC3477212 DOI: 10.1124/jpet.112.197038] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2012] [Accepted: 08/13/2012] [Indexed: 12/13/2022] Open
Abstract
Chronic alcohol abuse results in decreased bone mineral density (BMD), which can lead to increased fracture risk. In contrast, low levels of alcohol have been associated with increased BMD in epidemiological studies. Alcohol's toxic skeletal effects have been suggested to involve impaired vitamin D/calcium homeostasis. Therefore, dietary vitamin D supplementation may be beneficial in reducing bone loss associated with chronic alcohol consumption. Six-week-old female C57BL/6J mice were pair-fed ethanol (EtOH)-containing liquid diets (10 or 36% total calories) for 78 days. EtOH exposure at 10% calories had no effects on any measured bone or serum parameter. EtOH consumption at 36% of calories reduced BMD and bone strength (P<0.05), decreased osteoblastogenesis, increased osteoclastogenesis, suppressed 1,25-hydroxyvitamin D3 [1,25(OH)2D3] serum concentrations (P<0.05), and increased apoptosis in bone cells compared with pair-fed controls. In a second study, female mice were pair-fed 30% EtOH diets with or without dietary supplementation with vitamin D3 (cholecalciferol; VitD) for 40 days. VitD supplementation in the EtOH diet protected against cortical bone loss, normalized alcohol-induced hypocalcaemia, and suppressed EtOH-induced expression of receptor of nuclear factor-κB ligand mRNA in bone. In vitro, pretreatment of 1,25(OH)2D3 in osteoblastic cells inhibited EtOH-induced apoptosis. In EtOH/VitD mice circulating 1,25(OH)2D3 was lower compared with mice receiving EtOH alone (P<0.05), suggesting increased sensitivity to feedback control of VitD metabolism in the kidney. These findings suggest dietary VitD supplementation may prevent skeletal toxicity in chronic drinkers by normalizing calcium homeostasis, preventing apoptosis, and suppressing EtOH-induced increases in bone resorption.
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Affiliation(s)
- Kelly E Mercer
- Department of Pharmacology and Toxicology, University of Arkansas for Medical Sciences, Arkansas Children's Nutrition Center, 15 Children's Way, Little Rock, AR 72202, USA
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Rizzoli R, Body JJ, DeCensi A, Reginster JY, Piscitelli P, Brandi ML. Guidance for the prevention of bone loss and fractures in postmenopausal women treated with aromatase inhibitors for breast cancer: an ESCEO position paper. Osteoporos Int 2012; 23:2567-76. [PMID: 22270857 DOI: 10.1007/s00198-011-1870-0] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2011] [Accepted: 12/05/2011] [Indexed: 10/14/2022]
Abstract
UNLABELLED Aromatase inhibitors (AIs) are widely used in women with breast cancer, but they are known to increase bone loss and risk of fractures. Based on available evidence and recommendations, an ESCEO working group proposes specific guidance for the prevention of AIs-induced bone loss and fragility fractures. INTRODUCTION Aromatase inhibitors (AIs) are now the standard treatment for hormone receptor-positive breast cancer. However, deleterious effects of AIs on bone health have been reported. An ESCEO working group proposes guidance for the prevention of bone loss and fragility fractures in post-menopausal women with breast cancer receiving AIs. METHODS A panel of experts addressed the issue of skeletal effects of AIs and effectiveness of antifracture therapies for the prevention of AI-induced bone loss and fractures. Recommendations by national and international organizations, and experts' opinions on this topic were evaluated. RESULTS All aromatase inhibitors are associated with negative effects on the skeleton, resulting in bone loss and increased risk of fragility fractures. Current guidelines suggest approaches that differ both in terms of drugs proposed for fracture prevention and duration of treatment. CONCLUSION The ESCEO working group recommends that all AI-treated women should be evaluated for fracture risk. Besides general recommendations, zoledronic acid 4 mg i.v. every 6 months, denosumab s.c., or possibly oral bisphosphonates should be administered for the entire period of AI treatment to all osteoporotic women (T-score hip/spine <-2.5 or ≥ 1 prevalent fragility fracture), to women aged ≥ 75 irrespective of BMD, and to patients with T-score <-1.5 + ≥ 1 clinical risk factor or T-score <-1.0 + ≥ 2 clinical risk factors. Alternatively, therapy could be considered in patients with a FRAX-determined 10-year hip fracture probability ≥ 3%.
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Affiliation(s)
- R Rizzoli
- Division of Bone Diseases, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
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