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Yimaitong compiles and organizes, please do not reprint without authorization.
Introduction: What percentage of patients with osteoporosis treated with bisphosphonates have poor results (poor response to treatment)? What are the factors? The ultimate goal of osteoporosis treatment is to reduce the risk of fractures.
However, the absence of a fracture does not necessarily mean that the medication is effective.
There is evidence that the increase in bone mineral density (BMD) after treatment is related to the reduction in the incidence of fractures.
In clinical practice, double x-ray bone mineral density measurement (DXA) is usually used to evaluate the effect of drug treatment.
Although bisphosphonates have been given clinically, some patients may show bone loss (poor response to treatment) during treatment.
Such patients may have a greater risk of fractures than those who respond well to treatment, and may also be accompanied by secondary causes that have not yet been identified, requiring further attention.
What is the proportion of patients who have received bisphosphonate treatment but the effect is not good (the treatment response is not good)? What are the possible factors? Some scholars have explored this, and the research results will be published in the form of a poster at the 2021 ENDO conference.
Study description This is a single-center case-control study of patients with osteoporosis receiving bisphosphonate treatment.
The researchers used the same device (GE Lunar Prodigy) to perform DXA scans on participants to assess BMD levels (including baseline examination and follow-up).
Use t test or Mann-Whitney test (continuous) or chi-square test (categorical variable) to compare the clinical and biochemical parameters of IR patients and treatment responders.
Use logistic regression to assess the degree of correlation between different factors and IR.
IR-poor response to treatment, defined as a decrease in bone density detected by DXA that is greater than the least significant change (LSC) during follow-up.
15% of patients did not respond well to treatment.
Independent studies related to the use of anticonvulsants and IR enrolled 300 patients (2014-2018, 13% of men, with an average age of 68 years), of which 198 (66%) received Oral bisphosphonate treatment, 102 (34%) received zoledronic acid (ZA) treatment.
A total of 44 people (15%) had poor treatment effect, and they were IR population.
IR patients compared with good responders: Compared with good responders, IR patients had significantly higher use rates of oral bisphosphonates (82% vs.
63%, p=0.
016) and anticonvulsants at baseline (18% vs.
.
7%, p=0.
015), other baseline parameters are similar.
In addition, compared with good responders, IR patients had a lower percentage change in CTX after treatment (median: -37% vs.
-57%, p=0.
029), and serum CTX levels after treatment were higher (median: 236pg/mL vs.
165pg/mL, p=0.
004).
The possibility of IR in the oral bisphosphonate group was higher than that in the ZA group (OR 2.
61, IC95% 1.
16-5.
81, p=0.
002) and the anticonvulsant group (OR 2.
94, IC95% 1.
19-7.
25, p=0.
019) ).
Discussion and Summary Long-term compliance with oral bisphosphonates is usually low.
In this real-world retrospective study, treatment adherence was not assessed by verification tools.
Therefore, it cannot be determined whether the greater proportion of IR in patients receiving oral medications is related to poor drug compliance.
Patients taking chronic anti-epileptic drugs may experience reduced bone density and increased risk of fractures.
It is unclear whether the underlying pathogenesis is related to the direct effects of these drugs on bone health, or to confounding factors such as vitamin D deficiency, increased risk of falls, or trauma during seizures.
The possible effect of anticonvulsants on the response to bisphosphonate therapy has not been described, and further research is needed to clarify this issue.
In conclusion, this study found that about 15% of patients receiving bisphosphonate treatment had poor response to treatment and were independently related to the use of anticonvulsants, especially in patients receiving oral medications.
Yimaitong compiled and compiled from: Luciana Pinto Valadares, Bruno Silva de Araujo Ferreira, Bernardo Matos da Cunha, et al.
Factors Associated With Inadequate Response to Bisphosphonate Therapy in Patients With Osteoporosis in Real-Life Clinical Practice: a Single-Center Retrospective Analysis of 300 Patients.
Presented at: ENDO annual meeting; March 20-23,2021 (virtual meeting).
Introduction: What percentage of patients with osteoporosis treated with bisphosphonates have poor results (poor response to treatment)? What are the factors? The ultimate goal of osteoporosis treatment is to reduce the risk of fractures.
However, the absence of a fracture does not necessarily mean that the medication is effective.
There is evidence that the increase in bone mineral density (BMD) after treatment is related to the reduction in the incidence of fractures.
In clinical practice, double x-ray bone mineral density measurement (DXA) is usually used to evaluate the effect of drug treatment.
Although bisphosphonates have been given clinically, some patients may show bone loss (poor response to treatment) during treatment.
Such patients may have a greater risk of fractures than those who respond well to treatment, and may also be accompanied by secondary causes that have not yet been identified, requiring further attention.
What is the proportion of patients who have received bisphosphonate treatment but the effect is not good (the treatment response is not good)? What are the possible factors? Some scholars have explored this, and the research results will be published in the form of a poster at the 2021 ENDO conference.
Study description This is a single-center case-control study of patients with osteoporosis receiving bisphosphonate treatment.
The researchers used the same device (GE Lunar Prodigy) to perform DXA scans on participants to assess BMD levels (including baseline examination and follow-up).
Use t test or Mann-Whitney test (continuous) or chi-square test (categorical variable) to compare the clinical and biochemical parameters of IR patients and treatment responders.
Use logistic regression to assess the degree of correlation between different factors and IR.
IR-poor response to treatment, defined as a decrease in bone density detected by DXA that is greater than the least significant change (LSC) during follow-up.
15% of patients did not respond well to treatment.
Independent studies related to the use of anticonvulsants and IR enrolled 300 patients (2014-2018, 13% of men, with an average age of 68 years), of which 198 (66%) received Oral bisphosphonate treatment, 102 (34%) received zoledronic acid (ZA) treatment.
A total of 44 people (15%) had poor treatment effect, and they were IR population.
IR patients compared with good responders: Compared with good responders, IR patients had significantly higher use rates of oral bisphosphonates (82% vs.
63%, p=0.
016) and anticonvulsants at baseline (18% vs.
.
7%, p=0.
015), other baseline parameters are similar.
In addition, compared with good responders, IR patients had a lower percentage change in CTX after treatment (median: -37% vs.
-57%, p=0.
029), and serum CTX levels after treatment were higher (median: 236pg/mL vs.
165pg/mL, p=0.
004).
The possibility of IR in the oral bisphosphonate group was higher than that in the ZA group (OR 2.
61, IC95% 1.
16-5.
81, p=0.
002) and the anticonvulsant group (OR 2.
94, IC95% 1.
19-7.
25, p=0.
019) ).
Discussion and Summary Long-term compliance with oral bisphosphonates is usually low.
In this real-world retrospective study, treatment adherence was not assessed by verification tools.
Therefore, it cannot be determined whether the greater proportion of IR in patients receiving oral medications is related to poor drug compliance.
Patients taking chronic anti-epileptic drugs may experience reduced bone density and increased risk of fractures.
It is unclear whether the underlying pathogenesis is related to the direct effects of these drugs on bone health, or to confounding factors such as vitamin D deficiency, increased risk of falls, or trauma during seizures.
The possible effect of anticonvulsants on the response to bisphosphonate therapy has not been described, and further research is needed to clarify this issue.
In conclusion, this study found that about 15% of patients receiving bisphosphonate treatment had poor response to treatment and were independently related to the use of anticonvulsants, especially in patients receiving oral medications.
Yimaitong compiled and compiled from: Luciana Pinto Valadares, Bruno Silva de Araujo Ferreira, Bernardo Matos da Cunha, et al.
Factors Associated With Inadequate Response to Bisphosphonate Therapy in Patients With Osteoporosis in Real-Life Clinical Practice: a Single-Center Retrospective Analysis of 300 Patients.
Presented at: ENDO annual meeting; March 20-23,2021 (virtual meeting).
