Sixty spontaneous vertebral fractures after denosumab discontinuation in 15 women with early-stage breast cancer under aromatase inhibitors.

Details

Serval ID
serval:BIB_8D0CD026EA9F
Type
Article: article from journal or magazin.
Publication sub-type
Editorial
Collection
Publications
Institution
Title
Sixty spontaneous vertebral fractures after denosumab discontinuation in 15 women with early-stage breast cancer under aromatase inhibitors.
Journal
Breast cancer research and treatment
Author(s)
Gonzalez-Rodriguez E., Aubry-Rozier B., Stoll D., Zaman K., Lamy O.
ISSN
1573-7217 (Electronic)
ISSN-L
0167-6806
Publication state
Published
Issued date
01/2020
Peer-reviewed
Oui
Volume
179
Number
1
Pages
153-159
Language
english
Notes
Publication types: Journal Article
Publication Status: ppublish
Abstract
At denosumab discontinuation, bone turnover markers increase and the gained BMD is lost. In postmenopausal osteoporosis, there is an increased risk of spontaneous vertebral fractures (VFs) of about 1 to 10%, rarely described in women under denosumab for aromatase inhibitors (AI)-treated breast cancer. We aim to describe the characteristics of 15 patients under denosumab given for AI-treated early-stage breast cancer that presented VFs at its discontinuation.
Single-center retrospective case series of 15 patients. We report clinical data, dual X-ray absorptiometry values at denosumab initiation and discontinuation, and serum B-crosslaps dosage at the time of VF occurrence (before denosumab resumption).
Fifteen women (66.4 ± 7.1 years at denosumab discontinuation) that received AI for 5.0 ± 0.6 years, denosumab 60 mg for 8.2 ± 2.0 doses, and developed 60 VFs at denosumab discontinuation, were followed for 24.4 ± 9.5 months. Patients suffered from 1 to 11 (mean 4.0 ± 1.9) clinical VFs within 7 to 16 months after last denosumab injection. VFs developed earlier in patients with longer denosumab treatment (R <sup>2</sup> = 0.29, p = 0.04) and in patients without osteoporosis before denosumab (9.4 ± 2.0 vs. 13.0 ± 2.0 months; p = 0.005). Serum B-crosslaps at the time of VFs tended to be higher in patients with earlier VFs (R <sup>2</sup> = 0.47; p = 0.06) or with longer denosumab treatment (R <sup>2</sup> = 0.48; p = 0.06). Denosumab was resumed in all patients, then switched for a bisphosphonate in eight. No new VFs occurred during follow-up.
Despite an apparently low fracture risk, women under denosumab for AI-treated early-stage breast cancer develop spontaneous VFs at denosumab discontinuation. This risk increases with treatment duration and may be prevented by a potent bisphosphonate.
Keywords
Aromatase inhibitors, Breast cancer, Denosumab discontinuation, Rebound effect, Spontaneous multiple vertebral fractures
Pubmed
Create date
13/10/2019 19:51
Last modification date
05/02/2020 7:19
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