AbstractDenosumab discontinuation is associated with rapid reversal of bone turnover
suppression and with a considerable increase in fracture risk, including a
risk for multiple vertebral fractures (MVF). Long-term follow-up of patients
who sustained MVF after denosumab discontinuation has not been reported.
This case-series was aimed to provide a long-term follow-up on the
management and outcome of denosumab discontinuers who initially presented
with multiple vertebral fractures. Denosumab discontinuers were identified
from a computerized database of a large healthcare provider. Baseline and
follow-up clinical, laboratory, and imaging data were obtained from the
computerized database and electronic medical records. The post-denosumab
discontinuers MVF patients consisted of 12 women aged 71±12.
Osteoporotic fractures were prevalent before denosumab discontinuation in 6
of the patients. The majority received bisphosphonates before denosumab. MVF
occurred 134±76 days after denosumab discontinuation. The patients
were followed for a median of 36.5 (IQR 28.2, 42.5) months after MVF. Two
patients passed-away. Two patients suffered recurrent vertebral fractures.
Following MVF, patients were treated inconsistently with denosumab,
teriparatide, oral, and intravenous bisphosphonates, in various sequences.
Two patients underwent vertebroplasty/kyphoplasty. This long-term
follow-up of real-world patients with MVF following denosumab
discontinuation reveals that management is inconsistent, and recurrent
fractures are not uncommon. It calls for clear management guidelines for
patients with MVF after denosumab discontinuation and for special attention
to this high-risk group.
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