Can bone turnover markers help to define the suitability and duration of bisphosphonate drug holidays?
Background: On stopping bisphosphonate treatment, bone resorption may increase before evidence of a decrease in bone density. Offset of bisphosphonate effect may therefore be monitored by measuring C-terminal telopeptide (CTX) following long-term bisphosphonate treatment to inform clinical decisions...
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| Format: | Article |
| Language: | English |
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BioExcel Publishing Ltd
2020-05-01
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| Series: | Drugs in Context |
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| Online Access: | https://drugsincontext.com/can-bone-turnover-markers-help-to-define-the-suitability-and-duration-of-bisphosphonate-drug-holidays? |
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| author | Louise Statham Sharon Abdy Terry J Aspray |
| author_facet | Louise Statham Sharon Abdy Terry J Aspray |
| author_sort | Louise Statham |
| collection | DOAJ |
| description | Background: On stopping bisphosphonate treatment, bone resorption may increase before evidence of a decrease in bone density. Offset of bisphosphonate effect may therefore be monitored by measuring C-terminal telopeptide (CTX) following long-term bisphosphonate treatment to inform clinical decisions on drug holiday.
Methods: Retrospective analysis of 158 patients (83% female, mean age 71 years) starting a drug holiday had plasma CTX measured at discontinuation (baseline), n=138 and 4 months and n=136, and 12 months (n=100). Premenopausal mean CTX levels and the least significant change (LSC) detectable were used to define target thresholds for bone turnover.
Results: Following long-term bisphosphonate treatment (69% alendronic acid, 33% risedronate, mean duration 8 years SD 2.7), 32% patients had CTX above target (0.19 μg/L). In those with baseline CTX below threshold, 28% increased CTX to >0.19 μg/L and > LSC (0.06 μg/L) by 4 months (mean CTX increase 0.05 μg/L [95% confidence interval (CI): 0.04–0.06; p<0.0001]) and 53% by 12 months (mean CTX increase 0.09 μg/L [95% CI: 0.07–0.10; p<0.0001]), whilst 47% had no detectable changes in CTX over 12 months.
Conclusion: A third of patients showed inadequate suppression of CTX at baseline, despite long-term bisphosphonate treatment. Drug holiday may not be appropriate for this group, showing a poor therapeutic response or poor adherence. For more than a quarter of patients, bisphosphonate effects were wearing off at 4 months and around half by 12 months. We suggest CTX monitoring could identify those not experiencing a sustained bisphosphonate effect, including poorly adherence to therapy, and may be used during a drug holiday to prompt recommencement of therapy. |
| first_indexed | 2024-12-22T02:41:26Z |
| format | Article |
| id | doaj.art-c3a84a41ef2c41e5b5c396a95c3d7171 |
| institution | Directory Open Access Journal |
| issn | 1740-4398 1740-4398 |
| language | English |
| last_indexed | 2024-12-22T02:41:26Z |
| publishDate | 2020-05-01 |
| publisher | BioExcel Publishing Ltd |
| record_format | Article |
| series | Drugs in Context |
| spelling | doaj.art-c3a84a41ef2c41e5b5c396a95c3d71712022-12-21T18:41:38ZengBioExcel Publishing LtdDrugs in Context1740-43981740-43982020-05-0191510.7573/dic.2020-1-3Can bone turnover markers help to define the suitability and duration of bisphosphonate drug holidays?Louise StathamSharon Abdy Terry J AsprayBackground: On stopping bisphosphonate treatment, bone resorption may increase before evidence of a decrease in bone density. Offset of bisphosphonate effect may therefore be monitored by measuring C-terminal telopeptide (CTX) following long-term bisphosphonate treatment to inform clinical decisions on drug holiday. Methods: Retrospective analysis of 158 patients (83% female, mean age 71 years) starting a drug holiday had plasma CTX measured at discontinuation (baseline), n=138 and 4 months and n=136, and 12 months (n=100). Premenopausal mean CTX levels and the least significant change (LSC) detectable were used to define target thresholds for bone turnover. Results: Following long-term bisphosphonate treatment (69% alendronic acid, 33% risedronate, mean duration 8 years SD 2.7), 32% patients had CTX above target (0.19 μg/L). In those with baseline CTX below threshold, 28% increased CTX to >0.19 μg/L and > LSC (0.06 μg/L) by 4 months (mean CTX increase 0.05 μg/L [95% confidence interval (CI): 0.04–0.06; p<0.0001]) and 53% by 12 months (mean CTX increase 0.09 μg/L [95% CI: 0.07–0.10; p<0.0001]), whilst 47% had no detectable changes in CTX over 12 months. Conclusion: A third of patients showed inadequate suppression of CTX at baseline, despite long-term bisphosphonate treatment. Drug holiday may not be appropriate for this group, showing a poor therapeutic response or poor adherence. For more than a quarter of patients, bisphosphonate effects were wearing off at 4 months and around half by 12 months. We suggest CTX monitoring could identify those not experiencing a sustained bisphosphonate effect, including poorly adherence to therapy, and may be used during a drug holiday to prompt recommencement of therapy.https://drugsincontext.com/can-bone-turnover-markers-help-to-define-the-suitability-and-duration-of-bisphosphonate-drug-holidays?diphosphonatesbone resorptionosteoporosisbone remodellingcollagen type 1risedronic acidalendronate |
| spellingShingle | Louise Statham Sharon Abdy Terry J Aspray Can bone turnover markers help to define the suitability and duration of bisphosphonate drug holidays? Drugs in Context diphosphonates bone resorption osteoporosis bone remodelling collagen type 1 risedronic acid alendronate |
| title | Can bone turnover markers help to define the suitability and duration of bisphosphonate drug holidays? |
| title_full | Can bone turnover markers help to define the suitability and duration of bisphosphonate drug holidays? |
| title_fullStr | Can bone turnover markers help to define the suitability and duration of bisphosphonate drug holidays? |
| title_full_unstemmed | Can bone turnover markers help to define the suitability and duration of bisphosphonate drug holidays? |
| title_short | Can bone turnover markers help to define the suitability and duration of bisphosphonate drug holidays? |
| title_sort | can bone turnover markers help to define the suitability and duration of bisphosphonate drug holidays |
| topic | diphosphonates bone resorption osteoporosis bone remodelling collagen type 1 risedronic acid alendronate |
| url | https://drugsincontext.com/can-bone-turnover-markers-help-to-define-the-suitability-and-duration-of-bisphosphonate-drug-holidays? |
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