Abstract
BackgroundBisphosphonates are the most common treatment for osteoporosis with confirmed efficacy. However, less information is available on prolonged use. This study was performed to examine the risk of osteoporotic vertebral fractures during bisphosphonates holiday and estimate its predictors.ResultsForty-two patients completed 2-year fracture-free holiday; 7 had spontaneous vertebral fracture. Among baseline characteristics, age was significantly higher in fracture group (69.99 ± 3.62 vs. 75.37 ± 3.81; P value 0.007); other factors were comparable. Longitudinal changes analysis showed that only alkaline phosphatase (ALP) increment had significant group over time interaction (P value 0.002). The difference between baseline and clinical end-point serum collagen type 1 cross-linked C-telopeptid (CTX) was significant in both fracture and non-fracture groups, whereas femoral neck and total hip BMD decline was significant in fracture group only. Multivariate analysis showed that only age (OR, 1.43; p, 0.011) and history of previous fractures (OR, 13.59; p, 0.044) are significant predictors of vertebral fractures.ConclusionsThese results suggest that older age and history of previous fracture should be considered as risk factors for vertebral fractures during bisphosphonates holiday. Furthermore, femoral neck and total hip BMD decline could be related to vertebral fractures. By the same token, overt increase of ALP and CTX could be an indicator of fracture occurrence.
Highlights
Bisphosphonates are the most common treatment for osteoporosis with confirmed efficacy
The mean age (± Standard Deviation (SD)) of patients was 70.76 ± 4.08 years; age was significantly lower in non-fracture group (69.99 ± 3.62 vs. 75.37 ± 3.81; P value 0.007), while body mass index (BMI) was almost the same
Baseline The Fracture Risk Assessment Tool (FRAX) risk of major fracture, Falls Risk Assessment Tool (FRAT) score, alkaline phosphatase (ALP), Parathyroid hormone (PTH), and vitamin D was nonsignificantly higher in fracture group, whereas bone mineral density (BMD) measurements, Collagen type cross-linked C-telopeptid (CTX), and FRAX risk of hip fracture were numerically lower in fracture group of patients
Summary
Bisphosphonates are the most common treatment for osteoporosis with confirmed efficacy. Vertebral compression fractures are the most common osteoporotic fracture [1] which constitutes a main challenge in the elderly population. These fractures are associated with higher morbidity and mortality, in addition to the economic burden as a consequence of direct and indirect costs [2, 3]. Its efficacy, when used for 3–5 years, in increasing bone mineral density (BMD) and reducing fracture risk in postmenopausal women has been confirmed [4]. Previous studies have shown that BMD persist higher than baseline values after 5 years of alendronate holiday, even bone turnover remained partially suppressed, but the risk of clinical vertebral fractures was significantly increased [9, 10].
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