Potential excessive suppression of bone turnover with long-term oral bisphosphonate therapy in postmenopausal osteoporotic patients

Purpose Androgen-deprivation therapy (ADT) for prostate cancer is associated with bone loss and osteoporotic fractures. Our objective was to examine changes in bone density and turnover with sustained, discontinued, or delayed oral bisphosphonate therapy in men receiving ADT. Patients and Methods A total of 112 men with nonmetastatic prostate cancer receiving ADT were randomly assigned to alendronate 70 mg once weekly or placebo in a double-blind, partial-crossover trial with a second random assignment at year 2 for those who initially received active therapy. Outcomes included bone mineral density and bone turnover markers. Results Men initially randomly assigned to alendronate and randomly reassigned at year 2 to continue had additional bone density gains at the spine (mean, 2.3% ± 0.7) and hip (mean, 1.3% ± 0.5%; both P < .01); those randomly assigned to placebo in year 2 maintained density at the spine and hip but lost (mean, −1.9% ± 0.6%; P < .01) at the forearm. Patients randomly assigned to begin alendronate in year 2 experienced improvements in bone mass at the spine and hip, but experienced less of an increase compared with those who initiated alendronate at baseline. Men receiving alendronate for 2 years experienced a mean 6.7% (± 1.2%) increase at the spine and a 3.2% (± 1.5%) at the hip (both P < .05). Bone turnover remained suppressed. Conclusion Among men with nonmetastatic prostate cancer receiving ADT, once-weekly alendronate improves bone density and decreases turnover. A second year of alendronate provides additional skeletal benefit, whereas discontinuation results in bone loss and increased bone turnover. Delay in bisphosphonate therapy appears detrimental to bone health.

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Risk factors for development of atypical femoral fractures in patients on long-term oral bisphosphonate therapy

Bone ◽

10.1016/j.bone.2013.07.010 ◽

2013 ◽

Vol 56 (2) ◽

pp. 426-431 ◽

Cited By ~ 29

Author(s):

Paola Franceschetti ◽

Marta Bondanelli ◽

Gaetano Caruso ◽

Maria Rosaria Ambrosio ◽

Vincenzo Lorusso ◽

...

Keyword(s):

Risk Factors ◽

Femoral Fractures ◽

Bisphosphonate Therapy ◽

Atypical Femoral Fractures ◽

Oral Bisphosphonate

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Giant Osteoclast Formation and Long-Term Oral Bisphosphonate Therapy

New England Journal of Medicine ◽

10.1056/nejmc090167 ◽

2009 ◽

Vol 360 (16) ◽

pp. 1676-1678 ◽

Cited By ~ 2

Keyword(s):

Osteoclast Formation ◽

Bisphosphonate Therapy ◽

Oral Bisphosphonate ◽

Giant Osteoclast

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Treatment strategy for atypical ulnar fracture due to severely suppressed bone turnover caused by long-term bisphosphonate therapy: a case report and literature review

BMC Musculoskeletal Disorders ◽

10.1186/s12891-020-03824-y ◽

2020 ◽

Vol 21 (1) ◽

Cited By ~ 2

Author(s):

Kensaku Abe ◽

Hiroaki Kimura ◽

Norio Yamamoto ◽

Shingo Shimozaki ◽

Takashi Higuchi ◽

...

Keyword(s):

Literature Review ◽

Bone Turnover ◽

Bone Graft ◽

Treatment Strategy ◽

Bisphosphonate Therapy ◽

Bone Union ◽

Atypical Fracture ◽

Dual Plate ◽

Severely Suppressed Bone Turnover

Abstract Background Atypical fractures may occur due to the combined effect of severely suppressed bone turnover (SSBT) caused by long-term bisphosphonate treatment and chronic repetitive bone microdamage. Atypical fracture of the ulna due to SSBT is a rare entity; there is no standardized treatment strategy for this condition. We successfully treated a patient with atypical fracture of the ulna. Herein, we present this patient, review the relevant literature, and discuss the treatment strategy. Case presentation An 84-year-old woman presented with atypical fracture of the left ulnar shaft due to SSBT. She had a history of bisphosphonate therapy (ibandronate and alendronate) since more than 10 years; her bone turnover was severely suppressed. We performed open reduction and internal fixation (ORIF) using dual plate with some additional treatments. These included drilling and decortication, use of autogenous bone graft, low-intensity pulsed ultrasound (LIPUS) treatment, and administration of teriparatide. Finally, bone union was observed at 11 months after surgery. Conclusions Based on the literature review and our experience with this case, ORIF alone may not be adequate to achieve bone union; drilling, decortication, and use of cancellus bone graft is important to achieve favorable outcomes. Administration of teriparatide and LIPUS may facilitate early bone union, although further studies are required to provide more definitive evidence. Furthermore, ORIF using dual plate may help avoid implant failure owing to the long time required for bone union.

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