Multiple Rebound-Associated Vertebral Fractures after Denosumab Discontinuation: Is Prompt Antiresorptive Therapy Always Recommended,Even When the Risk of Fracture Seems Low? A Case Report.
Denosumab
aromatase inhibitors
bone
discontinuation
turnover.
vertebral fractures
Journal
Endocrine, metabolic & immune disorders drug targets
ISSN: 2212-3873
Titre abrégé: Endocr Metab Immune Disord Drug Targets
Pays: United Arab Emirates
ID NLM: 101269157
Informations de publication
Date de publication:
2021
2021
Historique:
received:
26
12
2020
revised:
28
04
2021
accepted:
29
04
2021
pubmed:
10
7
2021
medline:
5
4
2022
entrez:
9
7
2021
Statut:
ppublish
Résumé
Non-osteoporotic patients with endocrine-sensitive breast cancer are often treated with denosumab only during the anti-aromatase treatment, and when the anti-aromatase therapy is discontinued, no antiresorptive drug is prescribed. This case report clearly shows how even a patient with a low risk of fractures could have multiple rebound vertebral fractures after denosumab discontinuation. We report the case of a 60-year-old woman who suffered from multiple vertebral fractures only seven months after discontinuation of denosumab that had been administered to prevent bone loss related to three years of aromatase inhibitors as adjuvant therapy for breast cancer. No antiresorptive therapy was prescribed at the time of denosumab discontinuation, assuming that the patient had a low absolute risk of fracture after the withdrawal of the aromatase inhibitor. This case underlines the relative irrelevance of bone mineral density and clinical algorithms in predicting the risk of rebound-associated vertebral fractures after denosumab discontinuation and the strong recommendation to always switch to another antiresorptive therapy (such as zoledronic acid) immediately at the time of denosumab discontinuation.
Sections du résumé
BACKGROUND
Non-osteoporotic patients with endocrine-sensitive breast cancer are often treated with denosumab only during the anti-aromatase treatment, and when the anti-aromatase therapy is discontinued, no antiresorptive drug is prescribed. This case report clearly shows how even a patient with a low risk of fractures could have multiple rebound vertebral fractures after denosumab discontinuation.
CASE PRESENTATION
We report the case of a 60-year-old woman who suffered from multiple vertebral fractures only seven months after discontinuation of denosumab that had been administered to prevent bone loss related to three years of aromatase inhibitors as adjuvant therapy for breast cancer. No antiresorptive therapy was prescribed at the time of denosumab discontinuation, assuming that the patient had a low absolute risk of fracture after the withdrawal of the aromatase inhibitor.
CONCLUSION
This case underlines the relative irrelevance of bone mineral density and clinical algorithms in predicting the risk of rebound-associated vertebral fractures after denosumab discontinuation and the strong recommendation to always switch to another antiresorptive therapy (such as zoledronic acid) immediately at the time of denosumab discontinuation.
Identifiants
pubmed: 34238202
pii: EMIDDT-EPUB-116579
doi: 10.2174/1871530321666210708142127
doi:
Substances chimiques
Bone Density Conservation Agents
0
Denosumab
4EQZ6YO2HI
Types de publication
Case Reports
Langues
eng
Sous-ensembles de citation
IM
Pagination
2303-2306Informations de copyright
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