Abstract
Background
Osteoporosis is a skeletal and bone disorder characterized by bone fractures and decreased bone mineral density (BMD). Bisphosphonates have a great tendency to bind to minerals, and their long-term use can increase the risk of bone fragility in patients. Stopping bisphosphonates after a period of time is called a drug holiday (DH). Recent evidence has shown that patients’ BMD may decrease again during DH. However, few studies have been done in this regard. In the present study, we compared the BMD of postmenopausal women during bisphosphonates treatment and 1 year after DH.
Material and methods
A total of 202 patients were selected with osteopenia (n = 95) and osteoporosis (n = 107); they had been treated with alendronate for 5 years (a rheumatologist confirmed the diagnosis of osteopenia and osteoporosis) and had undergone DH for 1 year. At the arrival of all patients, BMD was checked with the DXA (dual-energy X-ray absorptiometry) method using the 2007 American Explorer model Hologic device based on the Caucasian race. One year later, patients were reassessed for BMD by the same device.
Result
The analysis of femoral neck (FN) and lumbar spine (LS) T-score indices in the osteopenia and the osteoporosis groups showed reduction after DH, and the difference was statistically significant in both groups (p = 0.001). After 1 year of stopping bisphosphonate treatment, the average of FN and LS BMD decreased in both groups (p = 0.001).
Conclusion
In general, it can be said that DH can reduce FN and LS T-scores. The results indicated a significant reduction in BMD after the DH period for both the osteoporosis and osteopenia groups in the early months. Also, the effect of DH in osteoporosis patients was more compared to the osteopenia individuals, which could have implications for their treatment approach, and also its effect on bone health.
Key Points • The DH can reduce FN and LS T-scores • The BMD reduced after the DH period for both the osteoporosis and osteopenia groups • After 1 year of stopping bisphosphonate treatment, the average of FN and LS BMD decreased in both groups |
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
Data availability
Data availability is the corresponding author’s responsibility.
References
Chen S, Zeng J, Huang L, Peng Y, Yan Z, Zhang A et al (2022) RNA adenosine modifications related to prognosis and immune infiltration in osteosarcoma. J Transl Med 20(1):228
Song Z-H, Xie W, Zhu S-Y, Pan J-J, Zhou L-Y, He C-Q (2018) Effects of PEMFs on Osx, Ocn, TRAP, and CTSK gene expression in postmenopausal osteoporosis model mice. Int J Clin Exp Pathol 11(3):1784
Ji MX, Yu Q (2015) Primary osteoporosis in postmenopausal women. Chronic Dis Transl Med 1(1):9–13
Chen S, Li Y, Zhi S, Ding Z, Huang Y, Wang W et al (2020) lncRNA Xist regulates osteoblast differentiation by sponging miR-19a-3p in aging-induced osteoporosis. Aging Dis 11(5):1058
Li J, Sun Y, Chen Z, Xie X, Gu F, Bi S et al (2022) Effects of bisphosphonates treatments in osteopenic older women: a systematic review and meta-analysis. Front Pharmacol 13:892091
Zhang Y, Zhao C, Zhang H, Chen M, Meng Y, Pan Y et al (2023) Association between serum soluble α-klotho and bone mineral density (BMD) in middle-aged and older adults in the United States: a population-based cross-sectional study. Aging Clin Exp Res 35(10):2039–2049
Al-Helal B, Abdallah E, Asad R, Kassab M, Al Yousef A, Nessim G et al (2022) Assessment the efficacy and safety of denosumab use for treatment of osteoporosis in hemodialysis patients. J Ren Endocrinol 8:e21062
Karimifar M, Botlani N, Salari A (2020) A randomized clinical trial on improving osteopenia in postmenopausal women after two years of preventive treatment with alendronate; a dose of 35 mg per week is more effective or a dose of 70 mg? J Prev Epidemiol 5(1):e16-e
Khalili P, Maddah R, Maleknia M, Shateri Amiri B, Forouzani F, Hasanvand A et al (2023) Evaluation of genes and molecular pathways involved in the progression of monoclonal gammopathy of undetermined significance (MGUS) to multiple myeloma: a systems biology approach. Mol Biotechnol 65(8):1275–1286
Sanderson J, Martyn-St James M, Stevens J, Goka E, Wong R, Campbell F et al (2016) Clinical effectiveness of bisphosphonates for the prevention of fragility fractures: a systematic review and network meta-analysis. Bone 89:52–58
Hayes KN, Winter EM, Cadarette SM, Burden AM (2021) Duration of bisphosphonate drug holidays in osteoporosis patients: a narrative review of the evidence and considerations for decision-making. J Clin Med 10(5):1140. https://doi.org/10.3390/jcm10051140
McClung MR (2016) Cancel the denosumab holiday. Osteoporos Int 27(5):1677–1682. https://doi.org/10.1007/s00198-016-3553-3
Sharafeddin F, Esfahan SZ, Keshavarz R, Goudarzi G (2024) Denosumab for osteoporosis in patients suffering from chronic kidney disease; a review on current data. Journal of Parathyroid Disease 12:e11242
Anagnostis P, Paschou SA, Mintziori G, Ceausu I, Depypere H, Lambrinoudaki I et al (2017) Drug holidays from bisphosphonates and denosumab in postmenopausal osteoporosis: EMAS position statement. Maturitas 101:23–30
Chen Y, Xiang J, Wang Z, Xiao Y, Zhang D, Chen X et al (2015) Associations of bone mineral density with lean mass, fat mass, and dietary patterns in postmenopausal Chinese women: a 2-year prospective study. PLoS ONE 10(9):e0137097
Bindon B, Adams W, Balasubramanian N, Sandhu J, Camacho P (2018) Osteoporotic fractures during bisphosphonate drug holiday. Endocr Pract 24(2):163–169
Wang M, Wu YF, Girgis CM (2022) Bisphosphonate drug holidays: evidence from clinical trials and real-world studies. JBMR plus 6(6):e10629
McNabb BL, Vittinghoff E, Schwartz AV, Eastell R, Bauer DC, Ensrud K et al (2013) BMD changes and predictors of increased bone loss in postmenopausal women after a 5-year course of alendronate. J Bone Miner Res 28(6):1319–1327
Mignot M, Taisne N, Legroux I, Cortet B, Paccou J (2017) Bisphosphonate drug holidays in postmenopausal osteoporosis: effect on clinical fracture risk. Osteoporos Int 28:3431–3438
Rutendo R, Farzahna M, Frederick R (2021) Impact of a bisphosphonate drug holiday on the bone mineral density in patients with osteoporosis. Wits J Clin Med 3(2):101–108
Naylor K, Bradburn M, Paggiosi M, Gossiel F, Peel N, McCloskey E et al (2018) Effects of discontinuing oral bisphosphonate treatments for postmenopausal osteoporosis on bone turnover markers and bone density. Osteoporos Int 29:1407–1417
Acknowledgements
We wish to thank all our colleagues at Isfahan University of Medical Science.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Ethical approval
All the procedures performed in the studies involving human participants were in accordance with the ethical standards of the local ethics committee of Isfahan University of Medical Science (IR.MUI.MED.REC.1401.090), as well as the 1964 Helsinki Declaration.
Consent for publication
Not applicable.
Disclosures
None.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Rizi, M.M., Salari, A., Salesi, M. et al. Comparison of bone mineral density of osteoporotic and osteopenia menopausal women treated with oral bisphosphonates before stopping the treatment and 1 year after drug holiday period. Clin Rheumatol 43, 1375–1379 (2024). https://doi.org/10.1007/s10067-024-06906-7
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10067-024-06906-7