Dr. Sheila Rice and her colleagues Dr. Pelin Batur, Paola Barrios and Dr. Andrea Sikon, recently published a high-impact clinical update on Osteoporosis Management in the Journal of Women’s Health. The paper highlighted findings on:
- the safety of long-term use of denusomab (brand name Prolia -an osteoporosis treatment drug) and bisphosphonates (medication class that include brand names: Fosamax, Actonel, Boniva and Reclast)
- fracture risk after discontinuing menopausal hormone therapy
- calcium intake and cardiovascular risk
- the value of repeat bone density tests to monitor those on osteoporosis treatment
A summary of the clinical update can be found below.
Summary of Findings For Safety of Long-Term Antiresorptive Osteoporosis Medication Use
Studies touting the benefits of denusomab treatment concluded that increased bone mineral density (BMD) and decreased factures were reported after three years of treatment. An extended study then showed that longer term exposure (up to eight years) of the medication resulted in sustained reduction in bone loss and increased bone mineral density (BMD) at all sites measured (including the spine and hip).
The update also concluded that bisphosphonates (BPs) remain the most common pharmacologic osteoporosis therapy, with proven efficacy at reducing hip, vertebral, and nonvertebral fractures. Sustained therapeutic effects are seen after cessation of BPs due to their prolonged half-life in the body.
This clinical update also highlighted a two-decade duration study that provided reassurance that the total risk of atypical fractures (subtrochanteric femur or femoral shaft) did not increase over the first 10 years of use of alendronate, and was accompanied by an adjusted 30% risk of reduction in hip fractures.
Summary of Findings for Fracture Rates After MHT Discontinuation
The large study suggests that discontinuation of Menopausal Hormone Therapy does not seem to result in an increase in fracture rates among postmenopausal women. This provided valuable information for counseling women who are considering stopping MHT but are concerned about the adverse bone health consequences.
Summary of Findings for Calcium Intake and Cardiovascular Disease Risk
Concerns have been raised regarding a potential association between oral calcium intake and increased risk of cardiovascular disease (CVD), but data are inconsistent. It appears calcium derived from supplements may pose a higher risk for CVD than calcium obtained from dietary sources.
The studies showed that as long as the total oral calcium intake is within the normal recommended allowance limits and is predominately obtained from dietary sources, it does not seem to increase the risk of CVD. Although increased use of calcium supplements may be associated with an increase in coronary artery calcification (CAC), it is unclear whether this is clinically significant.
Summary of Findings for Value of Repeat DXA Scanning
Multiple medical societies have widely accepted recommendations for initial Dual-energy X-ray (DXA) or bone density scans, however there are uncertainties regarding the role of DXA scans to monitor response to treatment.
The studies concluded that treatment-related increases in total hip bone mineral density (BMD), compared to attaining BMD stability, are associated with reduced fracture risk. In addition, decreases in BMD are highly correlate with a greater fracture risk. The follow-up DXA scan has value in not only better understanding the patient’s fracture risk but may also help identify those who are not adherent to their osteoporosis therapy.