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.

The effect of kyphoplasty and vertebroplasty on denosumab discontinuation rebound fractures

“…The reason why there are new fractures has not been clarified yet, but it has been suggested that the forces applied to the vertebrae change due to the infused orthopaedic cement 28,29,36 . Many case series reports have shown that in a short post-operative period new vertebrae fractures do occur [37][38][39][40][41] .…”