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Second rebound-associated vertebral fractures after denosumab discontinuation

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Abstract

Summary

Here, we report the case of a 69-year-old female who discontinued denosumab to undergo dental treatment. She subsequently suffered rebound-associated vertebral fractures (RVFs) twice. Denosumab is approved in several countries for osteoporosis treatment. Its discontinuation can result in bone turnover rebound increase and rapid bone mineral density loss. Rebound-associated vertebral fractures (RVFs) after discontinuing denosumab have been widely reported. We previously reported the case of a patient who suffered RVFs after discontinuing denosumab to undergo dental treatment. A 69-year-old female suffered five acute VFs 10 months after the last denosumab injection. The current report identifies the risks associated with denosumab discontinuation to undergo dental treatment. The patient described in this report also underwent an additional clinical course after the first RVFs. Next month after the first RVFs, she developed severe back pain when she changed her posture. Magnetic resonance imaging showed new RVFs at T9 and T12 levels. This case indicates that RVFs may occur more than once. In addition, it suggests that additional denosumab injections do not completely eliminate the risk of RVFs.

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References

  1. Martín-Merino E, Huerta-Álvarez C, Prieto-Alhambra D, Montero-Corominas D (2017) Cessation rate of anti-osteoporosis treatments and risk factors in Spanish primary care settings: a population-based cohort analysis. Arch Osteoporos 12(1):39

    Article  Google Scholar 

  2. Bone HG, Bolognese MA, Yuen CK, Kendler DL, Miller PD, Yang YC, Grazette L, San Martin J, Gallagher JC (2011) Effects of denosumab treatment and discontinuation on bone mineral density and bone turnover markers in postmenopausal women with low bone mass. J Clin Endocrinol Metab 96(4):972–980

    Article  CAS  Google Scholar 

  3. Anastasilakis AD, Polyzos SA, Makras P, Aubry-Rozier B, Kaouri S, Lamy O (2017) Clinical features of 24 patients with rebound-associated vertebral fractures after denosumab discontinuation: systematic review and additional cases. J Bone Miner Res 32(6):1291–1296

    Article  CAS  Google Scholar 

  4. Niimi R, Kono T, Nishihara A, Hasegawa M, Kono T, Sudo A (2018) Rebound-associated vertebral fractures after discontinuation of denosumab for the treatment of maxillitis. Osteoporos Int 29(3):769–772

    Article  CAS  Google Scholar 

  5. McClung MR (2016) Cancel the denosumab holiday. Osteoporos Int 27(5):1677–1682

    Article  CAS  Google Scholar 

  6. Horne AM, Mihov B, Reid IR (2018) Bone loss after romosozumab/denosumab: effects of bisphosphonates. Calcif Tissue Int 103(1):55–61

    Article  CAS  Google Scholar 

  7. O'Halloran M, Boyd NM, Smith A (2014) Denosumab and osteonecrosis of the jaws - the pharmacology, pathogenesis and a report of two cases. Aust Dent J 59(4):516–519

    Article  CAS  Google Scholar 

  8. Lamy O, Gonzalez-Rodriguez E, Stoll D, Hans D, Aubry-Rozier B (2017) Severe rebound-associated vertebral fractures after denosumab discontinuation: 9 clinical cases report. J Clin Endocrinol Metab 102(2):354–358

    Article  Google Scholar 

  9. Brown JP, Roux C, Törring O, Ho PR, Beck Jensen JE, Gilchrist N, Recknor C, Austin M, Wang A, Grauer A, Wagman RB (2013) Discontinuation of denosumab and associated fracture incidence: analysis from the fracture reduction evaluation of denosumab in osteoporosis every 6 months (FREEDOM) trial. J Bone Miner Res 28(4):746–752

    Article  CAS  Google Scholar 

  10. Cummings SR, Ferrari S, Eastell R, Gilchrist N, Jensen JB, McClung M, Roux C, Törring O, Valter I, Wang AT, Brown JP (2018) Vertebral fractures after discontinuation of denosumab: a post hoc analysis of the randomized placebo-controlled FREEDOM trial and its extension. J Bone Miner Res 33(2):190–198

    Article  CAS  Google Scholar 

  11. Reid IR, Horne AM, Mihov B, Gamble GD (2017) Bone loss after denosumab: only partial protection with zoledronate. Calcif Tissue Int 101(4):371–374

    Article  CAS  Google Scholar 

  12. Leaney A, Sztal-Mazer S (2018) Rebound vertebral fracture in the dental chair during a tooth extraction whilst on a treatment holiday from denosumab to avoid ONJ! Bone 108:43

    Article  Google Scholar 

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Authors and Affiliations

  1. Niimi Orthopaedic Clinic, Kuwana City, Mie, 511-0934, Japan

    Rui Niimi

  2. Department of Orthopaedic Surgery, Tomidahama Hospital, 26-14, Tomidahamacho, Yokkaichi City, Mie, 510-8008, Japan

    Toshibumi Kono, Atsushi Nishihara & Toshihiko Kono

  3. Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie-ken, 514-8507, Japan

    Masahiro Hasegawa & Akihiro Sudo

Authors
  1. Rui Niimi
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  2. Toshibumi Kono
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  3. Atsushi Nishihara
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  4. Masahiro Hasegawa
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  5. Toshihiko Kono
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  6. Akihiro Sudo
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Correspondence to Rui Niimi.

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Niimi, R., Kono, T., Nishihara, A. et al. Second rebound-associated vertebral fractures after denosumab discontinuation. Arch Osteoporos 15, 7 (2020). https://doi.org/10.1007/s11657-019-0676-0

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  • DOI: https://doi.org/10.1007/s11657-019-0676-0

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