ABSTRACT
INTRODUCTION: Rapid descent in bone mineral density (BMD) and ascent in bone turnover marker (BTM) occur within the short period following denosumab (Dmab) discontinuation. In addition, the incidence of vertebral fracture also rises within the short period. The purpose of this study is to investigate the effects of sequential therapy using zoledronic acid (ZOL) on any adverse events after Dmab discontinuation. MATERIALS AND METHODS: This study was a multicenter retrospective observational study, and the subjects were osteoporosis patients who visited our institutions between 2013 and 2018. We performed sequential therapy using ZOL for 30 patients who had difficulty continuing Dmab, due to physical or social reasons, and investigated the fracture incidence and BMD/BTM changes at 4 time points (at the start of Dmab, the start of ZOL, 6 months after ZOL and 12 months after ZOL). RESULTS: No new vertebral/nonvertebral fractures were observed at each time point after switching from Dmab to ZOL in any of the 30 patients. The BMD/BTM changes were evaluated in 18 of the 30 cases, since all data of lumbar/femoral neck BMDs and TRACP-5b at 4 time points was only available in 18 cases. BMDs significantly increased at each time point compared with that at the start of Dmab. Serum TRACP-5b significantly decreased at each time point compared with that at the start of Dmab. CONCLUSION: It was suggested that sequential therapy using ZOL could suppress the decrease of BMD, and increase of BTM, if the period of Dmab administration was less than 3 years.
Subject(s)
Denosumab/therapeutic use , Withholding Treatment , Zoledronic Acid/therapeutic use , Aged , Aged, 80 and over , Biomarkers/blood , Bone Density/drug effects , Bone Density Conservation Agents/adverse effects , Bone Density Conservation Agents/therapeutic use , Bone Remodeling/drug effects , Denosumab/adverse effects , Female , Fractures, Bone/blood , Fractures, Bone/epidemiology , Fractures, Bone/physiopathology , Humans , Male , Middle Aged , Osteoporosis/blood , Retrospective Studies , Tartrate-Resistant Acid Phosphatase/blood , Zoledronic Acid/adverse effectsABSTRACT
An 81-year-old female patient underwent arthroscopic repair of rotator cuff and provided cervical epidural catheterization for postoperative analgesia. On postoperative day (POD) 4 she developed fever and complained of neck pain and numbness in her fingers. Magnetic resonance imaging showed cervical epidural abscess at C6-7. Surgical decompression was performed and antibiotics were given to the patient on POD 5. Fortunately, she recovered fully from the symptoms after the surgery and no neurological deficit remained at discharge.
