Osteoporosis Treatment: Not Easy

EditorialsFebruary 2023Osteoporosis Treatment: Not EasySusan M. Ott, MDSusan M. Ott, MDUniversity of Washington, Seattle, WashingtonAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M22-3580 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail This issue includes a "living systematic review" and a "living guideline" on osteoporosis treatment recognizing that, as new evidence emerges, updates and changes in recommendations may become necessary (1, 2). My view is that an immediate update is necessary to address the severity of bone loss and the high risk for vertebral fractures after discontinuation of denosumab. An early report of participants from the main clinical trial who discontinued after 10 years showed losses ranging from 5.2% to 17% at the spine and from 6.0% to 19.1% at the hip (3). Reports of patients who develop multiple vertebral compression fractures ...References1. Ayers C, Kansagara D, Lazur B, et al. Effectiveness and safety of treatments to prevent fractures in people with low bone mass or primary osteoporosis. A living systematic review and network meta-analysis for the American College of Physicians. Ann Intern Med. 2023;176:182-195. doi:10.7326/M22-0684 LinkGoogle Scholar2. Qaseem A, Hicks LA, Etxeandia-Ikobaltzeta I, et al; for the Clinical Guidelines Committee of the American College of Physicians. Pharmacologic treatment of primary osteoporosis or low bone mass to prevent fractures in adults. A living clinical guideline from the American College of Physicians. Ann Intern Med. 2023;176:224-238. doi:10.7326/M22-1034 LinkGoogle Scholar3. Popp AW, Varathan N, Buffat H, et al. Bone mineral density changes after 1 year of denosumab discontinuation in postmenopausal women with long-term denosumab treatment for osteoporosis. Calcif Tissue Int. 2018;103:50-4. [PMID: 29380013] doi:10.1007/s00223-018-0394-4 CrossrefMedlineGoogle Scholar4. Lyu H, Yoshida K, Zhao SS, et al. Delayed denosumab injections and fracture risk among patients with osteoporosis: a population-based cohort study. Ann Intern Med. 2020;173:516-26. [PMID: 32716706] doi:10.7326/M20-0882 LinkGoogle Scholar5. Tsourdi E, Zillikens MC, Meier C, et al. Fracture risk and management of discontinuation of denosumab therapy: a systematic review and position statement by ECTS. J Clin Endocrinol Metab. 2020. [PMID: 33103722] doi:10.1210/clinem/dgaa756 CrossrefMedlineGoogle Scholar6. Cosman F, Huang S, McDermott M, et al. Multiple vertebral fractures after denosumab discontinuation: FREEDOM and FREEDOM extension trials additional post hoc analyses. J Bone Miner Res. 2022;37:2112-20. [PMID: 36088628] doi:10.1002/jbmr.4705 CrossrefMedlineGoogle Scholar7. McDonald MM, Khoo WH, Ng PY, et al. Osteoclasts recycle via osteomorphs during RANKL-stimulated bone resorption. Cell. 2021;184:1330-47.e13. [PMID: 33636130] doi:10.1016/j.cell.2021.02.002 CrossrefMedlineGoogle Scholar8. Ravn P, Bidstrup M, Wasnich RD, et al. Alendronate and estrogen-progestin in the long-term prevention of bone loss: four-year results from the early postmenopausal intervention cohort study. A randomized, controlled trial. Ann Intern Med. 1999;131:935-42. [PMID: 10610644] doi:10.7326/0003-4819-131-12-199912210-00005 LinkGoogle Scholar9. Nelson HD, Rizzo J, Harris E, et al; Study of Osteoporotic Fractures Research Group. Osteoporosis and fractures in postmenopausal women using estrogen. Arch Intern Med. 2002;162:2278-84. [PMID: 12418942] doi:10.1001/archinte.162.20.2278 CrossrefMedlineGoogle Scholar10. Hodis HN, Mack WJ. Menopausal hormone replacement therapy and reduction of all-cause mortality and cardiovascular disease: it is about time and timing. Cancer J. 2022;28:208-23. [PMID: 35594469] doi:10.1097/PPO.0000000000000591 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: University of Washington, Seattle, WashingtonDisclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M22-3580.Corresponding Author: Susan M. Ott, MD, Bone and Joint Center, 4245 Roosevelt Way NE, Seattle, WA 98015-6920; e-mail, [email protected]washington.edu.This article was published at Annals.org on 3 January 2023. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoEffectiveness and Safety of Treatments to Prevent Fractures in People With Low Bone Mass or Primary Osteoporosis: A Living Systematic Review and Network Meta-analysis for the American College of Physicians Chelsea Ayers , Devan Kansagara , Brittany Lazur , Rongwei Fu , Amy Kwon , and Curtis Harrod Metrics February 2023Volume 176, Issue 2Page: 278-279KeywordsBone fractureBone mineral densityOsteoporosisPreventive medicineSystematic reviews ePublished: 3 January 2023 Issue Published: February 2023 Copyright & PermissionsCopyright © 2023 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...