Multiple vertebral fractures after suspension of denosumab. A series of
56 cases.
Abstract
Background: Denosumab is a monoclonal antibody approved for the
treat-ment of postmenopausal osteoporosis. The withdrawal of denosumab
produc-es an abrupt loss of bone mineral density and may cause multiple
vertebral fractures (MVF). Objective: To study the clinical, biochemical
and densitometric characteristics in a large series of postmenopausal
women who suffered MVF after deno-sumab withdrawal. Likewise, we try to
identify those factors related to the presence of a greater number of
vertebral fractures (VF). Patients and Methods: 56 patients (54 women)
who suffered MVF after re-ceiving denosumab at least for 3 consecutive
years and abruptly suspended it. A clinical examination was carried out.
Biochemical bone remodeling markers (BBRM) and bone densitometry at the
lumbar spine and proximal femur were measured. VF were diagnosed by MRI,
X-ray or both at dorsal and lumbar spine. Results: 56 patients presented
a total of 192 VF. 41 patients (73.2%) had not previously suffered VF.
After discontinuation of the drug, a statistically signifi-cant increase
in the BBRM was observed. In the multivariate analysis, only the time
that denosumab was previously received was associated with the pres-ence
of a greater number of VF (p = 0.04). Conclusions: We present the series
with the largest number of patients col-lected to date. 56 patients
accumulated 192 new VF. After the suspension of denosumab and the
production of MVF, an increase in the serum values of the BBRM. The time
of denosumab use was the only parameter associated with a greater number
of fractures.