Bisphosphonates Discontinuation linked to higher Verte Fracture Risk among high risk osteoporosis patients: Study
Researchers have discovered that stopping bisphosphonates is associated with a large risk of fractures, mainly in high-risk patients with osteoporosis. A recent study was conducted by Salmoral A. and colleagues which was published in the journal Osteoporosis International. This study sought to determine the incidence of fractures and associated risk factors following cessation of bisphosphonates, in addition to investigating alterations in BMD and BTMs over time, hence illuminating the effects of stopping therapy in clinical practice.
This was an observational retrospective study in 264 patients recruited from 14 rheumatology departments of Spain. Participants were postmenopausal women and men with osteoporosis who were on alendronate or risedronate for ≥5 years or zoledronate for ≥3 years and had stopped their treatment for ≥1 or ≥2 years, respectively.
Spinal X-rays were conducted before the end of the treatment and during follow-up if there was a suspicion of clinical vertebral fractures. BMD and BTMs were measured before discontinuation and at several time points following discontinuation. Patients were stratified into high-, moderate- and low-risk profiles on the basis of femoral neck T-scores, history of fractures, and duration of bisphosphonate use.
Key Findings
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12.3% of patients developed fractures post- discontinuation, and 50% were vertebral.
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10.41% of the high-risk patients had fracture incidence in the first year.
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The moderate- and low-risk patients had a very minimal risk of fracture, with 0.8% and 1.08%, respectively.
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The BMD loss was substantial and was correlated with longer discontinuation periods at the femoral neck and total hip.
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(Procollagen Type I N-Terminal Propeptide) PINP was the most sensitive marker of changes in bone turnover post-discontinuation.
The study suggests that patients with high-risk osteoporosis should not be withdrawn on bisphosphonates since the risk of fractures, especially vertebral fractures, may begin as early as the first year after discontinuation. Hence, individualized treatment decisions will be important to optimize outcomes and prevent complications due to the cessation of treatment.
Reference:
Salmoral, A., Peris, P., López Medina, C., Flórez, H., Barceló, M., Pascual Pastor, M., Ros, I., Grados, D., Aguado, P., García, S., López, L., Gifre, L., Cerdá, D., Aguilar, F. J., Panero, B., Costa, E., Casado, E., Hernández, B., Martínez Ferrer, A., … for the OsteoResSer Working Group of the Spanish Society of Rheumatology. (2024). Bisphosphonate drug holidays in osteoporosis according to fracture risk profile. Osteoporosis International: A Journal Established as Result of Cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA. https://doi.org/10.1007/s00198-024-07309-9
