OBJECTIVE Several studies showed the occurrence of vertebral fracture (VFx) in patients discontinuing denosumab (Dmab), suggesting the need of bisphosphonate (BPs) therapy to mitigate this VFx risk increase. However, the morphometric VFx (morphoVFx) incidence after Dmab discontinuation and the BPs effect on VFx risk in this setting are still a matter of debate. DESIGN Retrospective, monocentric study. METHODS In 120 patients (111 females) discontinuing Dmab, 19 have not been treated (non-treated group: 16 females, aged 63.5 ± 15.0 years) and 101 patients have been treated (treated group: 95 females, aged 70.0 ± 10.6 years) with BPs (28 alendronate (ALN); 73 zoledronate ZOL), single infusion), respectively. We evaluated the incidence of both clinical VFx and morphoVFx in treated group and non-treated group. RESULTS Patients in treated group showed a 5.5% VFx incidence (n = 6, three clinical, three morpho VFx), which was anyway lower than non-treated group patients (n = 4, 21.1%, four clinical, three multiple, P = 0.029), despite a comparable FRAX score at the time of Dmab initiation. The logistic regression analysis showed that the VFx incidence was independently associated with the lack of BPs treatment (odds ratio: 13.9, 95% CI 1.7-111.1, P = 0.014), but not with the number of Dmab injections, age, duration of BPs before Dmab initiation, the BMD at Dmab withdrawal, and the prevalence of VFx at Dmab withdrawal. CONCLUSIONS The Dmab withdrawal is associated with an increased risk of clinical but not morphometric VFx. Therapy with ALN or with a single ZOL treatment is partially effective in reducing the increased VFx risk after Dmab withdrawal.

中文翻译：

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地诺单抗停药后双膦酸盐可降低椎体骨折发生率。

目标 几项研究表明，停用地诺单抗 (Dmab) 的患者会发生椎体骨折 (VFx)，这表明需要双膦酸盐 (BPs) 治疗来减轻这种 VFx 风险增加。然而，Dmab 停药后的形态测量 VFx (morphoVFx) 发生率以及在这种情况下 BPs 对 VFx 风险的影响仍然存在争议。设计 回顾性、单中心研究。方法 在 120 名停用 Dmab 的患者（111 名女性）中，19 名未接受治疗（未治疗组：16 名女性，年龄 63.5 ± 15.0 岁）和 101 名患者已接受治疗（治疗组：95 名女性，年龄 70.0 ± 10.6 岁）分别与 BPs（28 阿仑膦酸盐 (ALN)；73 唑来膦酸盐 ZOL），单次输注）。我们评估了治疗组和非治疗组临床 VFx 和 morphoVFx 的发生率。结果 治疗组患者的 VFx 发生率为 5.5%（n = 6，三个临床，三个形态 VFx），无论如何低于未治疗组患者（n = 4，21.1%，四个临床，三个多重，P = 0.029），尽管在 Dmab 启动时 FRAX 评分相当。逻辑回归分析显示，VFx 发生率与缺乏 BPs 治疗独立相关（比值比：13.9，95% CI 1.7-111.1，P = 0.014），但与 Dmab 注射次数、年龄、BPs 持续时间无关在 Dmab 开始之前，Dmab 戒断时的 BMD，以及 Dmab 戒断时的 VFx 患病率。结论 Dmab 退出与临床风险增加有关，但与形态测量 VFx 无关。ALN 治疗或单一 ZOL 治疗在降低 Dmab 停药后增加的 VFx 风险方面部分有效。