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Can bone turnover markers help to define the suitability and duration of bisphosphonate drug holidays?
BACKGROUND: On stopping bisphosphonate treatment, bone resorption may increase before evidence of a decrease in bone density. Offset of bisphosphonate effect may therefore be monitored by measuring C-terminal telopeptide (CTX) following long-term bisphosphonate treatment to inform clinical decisions...
Autores principales: | , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioExcel Publishing Ltd
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7216784/ https://www.ncbi.nlm.nih.gov/pubmed/32426015 http://dx.doi.org/10.7573/dic.2020-1-3 |
Sumario: | BACKGROUND: On stopping bisphosphonate treatment, bone resorption may increase before evidence of a decrease in bone density. Offset of bisphosphonate effect may therefore be monitored by measuring C-terminal telopeptide (CTX) following long-term bisphosphonate treatment to inform clinical decisions on drug holiday. METHODS: Retrospective analysis of 158 patients (83% female, mean age 71 years) starting a drug holiday had plasma CTX measured at discontinuation (baseline), n=138 and 4 months and n=136, and 12 months (n=100). Premenopausal mean CTX levels and the least significant change (LSC) detectable were used to define target thresholds for bone turnover. RESULTS: Following long-term bisphosphonate treatment (69% alendronic acid, 33% risedronate, mean duration 8 years SD 2.7), 32% patients had CTX above target (0.19 μg/L). In those with baseline CTX below threshold, 28% increased CTX to >0.19 μg/L and > LSC (0.06 μg/L) by 4 months (mean CTX increase 0.05 μg/L [95% confidence interval (CI): 0.04–0.06; p<0.0001]) and 53% by 12 months (mean CTX increase 0.09 μg/L [95% CI: 0.07–0.10; p<0.0001]), whilst 47% had no detectable changes in CTX over 12 months. CONCLUSION: A third of patients showed inadequate suppression of CTX at baseline, despite long-term bisphosphonate treatment. Drug holiday may not be appropriate for this group, showing a poor therapeutic response or poor adherence. For more than a quarter of patients, bisphosphonate effects were wearing off at 4 months and around half by 12 months. We suggest CTX monitoring could identify those not experiencing a sustained bisphosphonate effect, including poorly adherence to therapy, and may be used during a drug holiday to prompt recommencement of therapy. |
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