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J Bone Miner Res. 2018 Dec 7. doi: 10.1002/jbmr.3654. [Epub ahead of print]

Comparison of BMD Changes and Bone Formation Marker Levels 3 Years After Bisphosphonate Discontinuation: FLEX and HORIZON-PFT Extension I Trials.

Author information

1
Department of Medicine, University of California, San Francisco, CA, USA.
2
Medical Service, San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA.
3
Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA.
4
Department of Clinical Medicine, Columbia University, New York, NY, USA.
5
Clinical Research Center, Helen Hayes Hospital, West Haverstraw, NY, USA.
6
Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK.

Abstract

An ASBMR Task Force recommends a drug holiday for certain women treated for ≥5 years with oral alendronate or ≥3 years with intravenous zoledronic acid, with reassessment 2 to 3 years later. It is not known whether changes in bone mineral density (BMD) or bone turnover markers differ after oral or intravenous therapy. Our goal was to compare changes in BMD and procollagen type I N propeptide (PINP) after oral or intravenous bisphosphonate use. In the Fracture Intervention Trial Long-term Extension (FLEX), women who received a mean 5 years of alendronate were randomized to placebo or continued treatment. In the Health Outcomes and Reduced Incidence with Zoledronic Acid Once Yearly-Pivotal Fracture Trial Extension I (HORIZON-PFT E1), women who received 3 years of zoledronic acid were randomized to placebo or continued treatment. We examined the proportion of participants with BMD loss or PINP gain ≥ least significant change (LSC) and those whose values exceeded a threshold (T-score ≤-2.5 or PINP ≥36.0 ng/mL, a premenopausal median value). After 3 years of placebo, the FLEX group had greater mean total hip BMD decreases (-2.3% versus -1.2% in the HORIZON-PFT E1 group, p < 0.01) and greater rises in PINP (+11.6 ng/mL versus +6.7 ng/mL, p < 0.01). There was a greater proportion of individuals in FLEX with total hip BMD loss and PINP increases that exceeded LSC, and PINP values ≥36.0 ng/mL. In contrast, there were small changes in the proportion of women with femoral neck T-scores ≤-2.5 in both groups. In conclusion, 3 years after bisphosphonate discontinuation, a considerable proportion of former alendronate and zoledronic acid users had meaningful declines in total hip BMD and elevations in PINP. Despite a longer treatment course, alendronate may have a more rapid offset of drug effect than zoledronic acid.

KEYWORDS:

ANTIRESORPTIVES; BIOCHEMICAL MARKERS OF BONE TURNOVER; DXA; OSTEOPOROSIS

PMID:
30536713
DOI:
10.1002/jbmr.3654

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