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Published on: November 8, 2024
Fracture risk remains reduced one year after discontinuation of risedronate
N B Watts1, A Chines, W P Olszynski
1University of Cincinnati Bone Health and Osteoporosis Center, 222 Piedmont Avenue, Suite 4300, Cincinnati, OH 45219, USA. nelson.watts@uc.edu
Insights
Even after stopping risedronate treatment, bone mineral density decreased, but fracture risk remained significantly lower. This suggests long-term benefits for fracture prevention beyond the treatment period.
Area of Science:
- Osteoporosis research
- Pharmacology
- Bone health
Background:
- Bisphosphonate effects on bone mineral density (BMD) and bone turnover markers (BTM) may vary after treatment cessation.
- Understanding the persistence of therapeutic effects after discontinuing risedronate is crucial for long-term osteoporosis management.
Purpose of the Study:
- To investigate changes in BMD, BTM, and fracture risk one year after discontinuing a three-year risedronate treatment.
- To assess the long-term impact of risedronate therapy on skeletal health markers and fracture incidence.
Main Methods:
- A randomized controlled trial (VERT-NA study) involving patients treated with risedronate or placebo for three years.
- Post-treatment assessment included measuring BMD, BTM, and new morphometric vertebral fractures one year after therapy cessation.
Main Results:
- One year after stopping risedronate, BMD decreased but remained higher than baseline and placebo groups.
- Bone turnover markers returned to levels similar to the placebo group.
- Despite these changes, the incidence of new morphometric vertebral fractures was significantly lower (46% reduction) in the former risedronate group.
Conclusions:
- The fracture-reducing benefits of risedronate persist for at least one year after treatment discontinuation, even with decreases in BMD and normalization of BTM.
- Risedronate therapy may offer sustained protection against vertebral fractures beyond the active treatment phase.
Unlabelled:
One year after discontinuation of three year's treatment with risedronate, BMD decreased at the lumbar spine and femoral neck and bone turnover markers returned to control group levels. Despite these changes, the risk of new morphometric vertebral fractures remained lower in previous risedronate patients compared with previous control patients.
Introduction:
Differences in bisphosphonate pharmacology and pharmacokinetics could influence persistence or resolution of the effects once treatment is stopped. We investigated changes in intermediate markers--bone mineral density (BMD) and bone turnover markers (BTM)--and fracture risk after discontinuation of treatment with risedronate.
Methods:
Patients who received risedronate 5 mg daily (N = 398) or placebo (N = 361) during the VERT-NA study stopped therapy per protocol after 3 years but continued taking vitamin D (if levels at study entry were low) and calcium and were reassessed one year later.
Results:
In the year off treatment, spine BMD decreased significantly, but remained higher than baseline (p < or = 0.001) and placebo (p < 0.001), with similar findings at the femoral neck and trochanter. Urinary NTX and bone-specific alkaline phosphatase, which decreased significantly with treatment, were not significantly different from placebo after 1 year off treatment. Despite the changes in intermediate markers, the incidence of new morphometric vertebral fractures was 46% lower in the former risedronate group compared with the former placebo group (RR 0.54 [95% CI, 0.34, 0.86, p = 0.009]).
Conclusions:
Despite the apparent resolution of effect on BMD and BTM, the risk reduction of new vertebral fractures remained in the year after treatment with risedronate was stopped.
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