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Osteoporosis International
Published in: Osteoporosis International 6/2018

01-06-2018 | Original Article

Effects of discontinuing oral bisphosphonate treatments for postmenopausal osteoporosis on bone turnover markers and bone density

Authors: K. E. Naylor, M. Bradburn, M. A. Paggiosi, F. Gossiel, N. F. A. Peel, E. V. McCloskey, J. S. Walsh, R. Eastell

Published in: Osteoporosis International | Issue 6/2018

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Abstract

Summary

The antiresorptive potency varies between different bisphosphonates. We investigated the effect of stopping oral bisphosphonate treatment for postmenopausal osteoporosis (ibandronate, alendronate, risedronate) on BTMs and BMD. After stopping treatment, all three groups showed an increase in BTMs and a decrease in hip BMD; however, none returned to pre-treatment baseline values.

Introduction

Bisphosphonates (BPs) continue to suppress bone turnover markers (BTMs) after treatment has stopped, leading to the suggestion that a pause in treatment could be considered for low-risk patients. Indirect comparisons suggest that after cessation of treatment, the effects on bone may differ between drugs. We investigated the effects of stopping oral BP treatments for postmenopausal osteoporosis on BTMs and bone mineral density (BMD).

Methods

We studied postmenopausal osteoporotic women who had previously taken part in a 2-year randomised study of three oral BPs (ibandronate, alendronate, or risedronate). At the end of the study, women with hip BMD T-score > − 2.5 and considered clinically appropriate to discontinue treatment were invited to participate in a further 2-year observational study. Biochemical response was assessed using BTMs, and BMD was measured by dual-energy X-ray absorptiometry.

Results

All BTMs increased after treatment withdrawal but remained below the pre-treatment baseline with less suppression of BTMs for the risedronate group compared to alendronate and ibandronate up to 48 weeks. There was no difference between the BP groups 96 weeks after stopping treatment. The change in BMD during the 96 weeks after stopping treatment was − 1.6% (95% CI − 1.9 to − 1.2, P < 0.001) for the total hip and − 0.6% (95% CI − 1.1 to − 0.2, P = 0.17) at the lumbar spine with no difference between the three BP groups (P = 0.85 and P = 0.48, respectively).

Conclusion

For all treatment groups, there was an increase in BTMs and a decrease in hip BMD after stopping BPs for 2 years; however, none returned to pre-treatment baseline values.
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Metadata
Title
Effects of discontinuing oral bisphosphonate treatments for postmenopausal osteoporosis on bone turnover markers and bone density
Authors
K. E. Naylor
M. Bradburn
M. A. Paggiosi
F. Gossiel
N. F. A. Peel
E. V. McCloskey
J. S. Walsh
R. Eastell
Publication date
01-06-2018
Publisher
Springer London
Published in
Osteoporosis International / Issue 6/2018
Print ISSN: 0937-941X
Electronic ISSN: 1433-2965
DOI
https://doi.org/10.1007/s00198-018-4460-6

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