Fracturas vertebrales múltiples tras la suspensión de tratamiento con denosumab: serie de diez casos / Multiple vertebral fractures following discontinuation of denosumab treatment: ten clinical cases report

OBJETIVOS: Analizar las características clínicas y de metabolismo óseo de una serie de pacientes con fracturas vertebrales tras la suspensión de denosumab (DMab). MÉTODOS: Estudio observacional retrospectivo de 10 pacientes con fracturas vertebrales tras suspender DMab atendidas en el Servicio de Reumatología de un hospital español de tercer nivel entre 2015 y 2018. RESULTADOS: Se registraron un total de 49 fracturas espontáneas tras una media de 6 dosis de DMab y transcurridos 10,9 meses desde la suspensión del fármaco. El 90% había recibido tratamiento previo, 7 de 10 bisfosfonatos orales. Tras la suspensión, CTX y P1NP estaban elevados y la media de T-score en cuello femoral y columna lumbar fue menor que previo a DMab. Las vértebras más afectadas fueron L3, L5, D6, D7, D9 y D11. CONCLUSIÓN: La descripción de nuevos casos de fracturas vertebrales múltiples en los meses posteriores a la suspensión de DMab subraya la preocupación emergente en la comunidad científica siendo preciso apoyar en evidencias sólidas las nuevas recomendaciones sobre su manejo

OBJECTIVES: Analyse clinical and bone metabolism features in a case series of patients with multiple vertebral fractures after discontinuation of denosumab (DMab). METHODS: An observational descriptive study analysing data from ten patients with multiple vertebral fractures after DMab discontinuation that were admitted to our rheumatology department between 2015 and 2018. RESULTS: There were a total of 49 spontaneous fractures after an average of 6 DMab doses and 10.9 months from discontinuation. Ninety percent had already received treatment other than DMab 7 of 10 oral bisphosphonates. After discontinuation, CTX and P1NP remained elevated and mean T-score for femoral neck and lumbar spine was lower than before treatment. The most affected vertebrae were L3, L5, D6, D7, D9 and D11. CONCLUSION: This report of ten new cases suffering multiple vertebral fractures early after discontinuation of DMab highlights the emerging concern on the subject in the scientific community and the need to clarify its pathogenic mechanism, and to support by solid evidence the new recommendations on its management

Analysis of the Health and Budgetary Impact of Chondroitin Sulfate Prescription in the Treatment of Knee Osteoarthritis Compared to NSAIDs and COXIBs.

BACKGROUND: Chondroitin sulfate, alone or associated with glucosamine (CS), is an effective treatment of osteoarthritis, better tolerated than non-steroidal anti-inflammatory drugs (NSAIDs) and cyclooxygenase 2 inhibitors (COXIBs) at gastrointestinal, cardiovascular and renal levels. OBJECTIVE: To estimate the health impact (toxicity by NSAIDs/COXIBs avoided with CS with or without glucosamine) and economic impact (savings due to avoided toxicities) of treatment of knee osteoarthritis with CS compared to NSAIDs/COXIBs, as a consequence of the avoidance of mild-moderate or severe gastrointestinal adverse effects (GIAE), ischaemic heart disease (IHD), acute kidney insufficiency (AKI) and chronic kidney failure (CKF). METHODS: We compared the current situation (available reimbursed prescription with CS) with a hypothetical situation without CS (treatment only with NSAIDs/COXIBs). The frequency of GIAE, IHD, AKI and CKF with CS and NSAIDs/COXIBs was obtained from published ad hoc studies. The cost of AE management and of the drugs (180 days of treatment) was obtained from Spanish sources. A probabilistic economic model was made for a 3-year period, both at national (NHS) and regional levels. Sensitivity analyses were performed for different durations of treatment (90 and 240 days). RESULTS: In Spain, it is estimated that 519,130, 513,616 and 507,377 patients with knee osteoarthritis will be treated with NSAIDs/COXIBs and 112,775, 114,963 and 117,262 with CS in 2020, 2021 and 2022, respectively. Due to better CS tolerability, 55,098 mild-moderate GIAE, 3060 severe GIAE, 204 IHD, 1089 AKI and 733 CKF would be avoided in 3 years. Discounting the cost of the drugs, the three-year savings for the NHS would be 21.8 (12.7-29.5) million euros. CONCLUSION: Due to its better tolerability profile, CS treatment is expected to prevent thousands of AEs over the next 3 years, some of which may be life-threatening for patients, while generating considerable savings for the NHS.

Multiple vertebral fractures following discontinuation of denosumab treatment: Ten clinical cases report. / Fracturas vertebrales múltiples tras la suspensión de tratamiento con denosumab: serie de diez casos.

OBJECTIVES: Analyse clinical and bone metabolism features in a case series of patients with multiple vertebral fractures after discontinuation of denosumab (DMab). METHODS: An observational descriptive study analysing data from ten patients with multiple vertebral fractures after DMab discontinuation that were admitted to our rheumatology department between 2015 and 2018. RESULTS: There were a total of 49 spontaneous fractures after an average of 6 DMab doses and 10.9 months from discontinuation. Ninety percent had already received treatment other than DMab 7 of 10 oral bisphosphonates. After discontinuation, CTX and P1NP remained elevated and mean T-score for femoral neck and lumbar spine was lower than before treatment. The most affected vertebrae were L3, L5, D6, D7, D9 and D11. CONCLUSION: This report of ten new cases suffering multiple vertebral fractures early after discontinuation of DMab highlights the emerging concern on the subject in the scientific community and the need to clarify its pathogenic mechanism, and to support by solid evidence the new recommendations on its management.

Situación actual de los SYSADOA en España / Current status of symptomatic slow-acting drugs for osteoarthritis (SYSADOAs) in Spain

No disponible

[Rheumatology and osteoporosis (RETOSS): a vision of postmenopausal osteoporosis in rheumatology departments throughout Spain]. / Reumatología y osteoporosis (RETOSS): osteoporosis posmenopáusica en la consulta de reumatología.

OBJECTIVE: To know the characteristics of the postmenopausal women with osteoporosis consulting Rheumatology Hospital Divisions in Spain. METHODS: An epidemiologic, observational, transverse and multicentric study was performed from June to September 2008 in 63 rheumatology divisions in Spain. Six hundred and twenty nine osteoporotic postmenopausal women were studied using a questionnaire designed to get demographic, clinical, radiological, bone density, and functional information. Every physician had to choose only one patient per day, usually the first woman to come in and fulfill the inclusion and exclusion criteria. RESULTS: Mean age of included women was 66,6 [9,2) years, weight:64,6[10,1] kg and body mass index: 26,1[4,1] kg/m(2). They were 3,1[2,8] cm shorter than the maximal historical height. 35,7% of them had a family history of fracture and 40,7% had a past history of fracture, of which 54,8% were vertebral fractures. Patients who received calcidiol <20 ng/ml sustained more falls (p=0,033) and fractures (p=0,006) than women receiving calcidiol >20 ng/ml. Risk of falls and fractures increased with advancing age and 51,5% of women who fell, had a fracture. 75% of women had poor calcium intake (≤400 mg/day). The Get up & go test showed a linear trend to an increased probability of >20s in relationship with the age as well as with an increased incidence of fractures. 71,8% of patients had back pain and in 85,3% it went from moderate to severe. IN CONCLUSION: Most osteoporotic postmenopausal Spanish women have a low calcium intake, one out of three has a family history of fractures that increases fracture incidence and this shows a relationship with age and functional capacity; four out of ten have had any type of fractures, one out of three have fallen during the past year and half of these present back pain. Calcidiol levels have been evaluated in a small group of patients.

Reumatología y osteoporosis (RETOSS): osteoporosis posmenopáusica en la consulta de reumatología / Rheumatology and osteoporosis (RETOSS): a vision of postmenopausal osteoporosis in rheumatology departments throughout Spain

Objetivo. Conocer las características de las mujeres posmenopáusicas con osteoporosis que acuden a las consultas hospitalarias de reumatología en España. Métodos. Desde junio a septiembre de 2008 se realizó un estudio epidemiológico, observacional, transversal y multicéntrico en 63 consultas de reumatología en toda España. Se evaluaron 629 mujeres posmenopáusicas con osteoporosis utilizando un cuestionario diseñado para recoger datos demográficos, clínicos, radiológicos, de densidad ósea y de función física. Cada médico participante escogió una paciente por día; la primera que cumplía los criterios de inclusión y exclusión. Resultados. La media de la edad fue de 66,6 (9,2) años, del peso fue de 64,6 (10,1)kg y del índice de masa corporal (IMC): 26,1 (4,1)kg/m2. La pérdida de talla media fue de 3,1 (2,8)cm en relación a la media de la talla histórica. El 35,7% tenía antecedentes familiares de fractura, el 40,7% había tenido alguna fractura, de las cuales el 54,8% eran fracturas vertebrales. En las pacientes que presentaban calcidiol <20ng/ml se observó una mayor frecuencia de caídas (p=0,033) y de fracturas (p=0,006), respecto al grupo con valores de calcidiol >20ng/ml. Se encontró un aumento significativo de la probabilidad de caídas asociadas a la edad, y el 51,5% de las mujeres que se había caído, había sufrido algún tipo de fractura por fragilidad. El 75% de las mujeres tenía una ingesta baja de calcio (400mg/d). El test Get up & go mostró un incremento significativo de la probabilidad de test > 20 segundos en relación con la edad, de forma lineal, y con un aumento de la incidencia de fracturas. El 71,8% de las pacientes tenía dolor de espalda y entre estas, el 85,3% presentaba dolor de moderado a severo. Conclusiones. La mayoría de las mujeres españolas posmenopáusicas con osteoporosis que acuden a las consultas de reumatología tiene una ingesta baja de calcio y un tercio de ellas tiene antecedentes familiares de fractura. La incidencia de fracturas muestra una clara relación con la edad, la capacidad funcional y el dolor de espalda. La determinación de la concentración de calcidiol sérico se realiza en un bajo porcentaje de pacientes (AU)

Objective. To know the characteristics of the postmenopausal women with osteoporosis consulting Rheumatology Hospital Divisions in Spain. Methods. An epidemiologic, observational, transverse and multicentric study was performed from June to September 2008 in 63 rheumatology divisions in Spain. Six hundred and twenty nine osteoporotic postmenopausal women were studied using a questionnaire designed to get demographic, clinical, radiological, bone density, and functional information. Every physician had to choose only one patient per day, usually the first woman to come in and fulfill the inclusion and exclusion criteria. Results. Mean age of included women was 66,6 [9,2) years, weight:64,6[10,1] kg and body mass index: 26,1[4,1] kg/m2. They were 3,1[2,8] cm shorter than the maximal historical height. 35,7% of them had a family history of fracture and 40,7% had a past history of fracture, of which 54,8% were vertebral fractures. Patients who received calcidiol <20ng/ml sustained more falls (p=0,033) and fractures (p=0,006) than women receiving calcidiol >20ng/ml. Risk of falls and fractures increased with advancing age and 51,5% of women who fell, had a fracture. 75% of women had poor calcium intake (<=400mg/day). The Get up & go test showed a linear trend to an increased probability of >20s in relationship with the age as well as with an increased incidence of fractures. 71,8% of patients had back pain and in 85,3% it went from moderate to severe. In conclusion. Most osteoporotic postmenopausal Spanish women have a low calcium intake, one out of three has a family history of fractures that increases fracture incidence and this shows a relationship with age and functional capacity; four out of ten have had any type of fractures, one out of three have fallen during the past year and half of these present back pain. Calcidiol levels have been evaluated in a small group of patients (AU)

Fractura vertebral aguda y técnicas de refuerzo vertebral / Acute vertebral fracture and vertebral reinforcement techniques

La alta incidencia de las fracturas por fragilidad y especialmente de las fracturas vertebrales (FV) en mujeres con osteoporosis posmenopáusica obliga a abordar este tema una y otra vez. En este manuscrito se actualizan los datos epidemiológicos que indican la magnitud del problema y se revisan alternativas de tratamiento farmacológico, tanto para disminuir el dolor producido por la FV como para prevenir la presentación de nuevas fracturas osteoporóticas de cualquier tipo, indicando los agentes antirresortivos y osteoformadores disponibles actualmente. En los casos de FV por compresión, en las que el tratamiento farmacológico habitual no produce mejoría del dolor y siempre que no existan contraindicaciones, puede ser muy apropiado realizar vertebroplastia o cifoplastia (AU)

The high incidence of fractures by fragility and, especially of the vertebral fractures in osteoporotic postmenopausal women, forces us to approach this subject once more. In this manuscript epidemiological data that indicates the magnitude of the problem will be updated. Treatment alternatives to decrease back pain produced by vertebral fracture are will be reviewed, and the prevention of the occurrence of new osteoporotic fractures of any type, through the administration of suitable antiresorptive and bone-forming pharmacological agents to increase bone mineral density will also be addressed. In some patients with painful vertebral compression fractures it is possible obtain an analgesic effect by percutaneous vertebroplasty or by kiphoplasty using polymethylmetacrilate cement or calcium- phosphate cement, injected into vertebral bodies (AU)

[Acute vertebral fracture and vertebral reinforcement techniques]. / Fractura vertebral aguda y técnicas de refuerzo vertebral.

The high incidence of fractures by fragility and, especially of the vertebral fractures in osteoporotic postmenopausal women, forces us to approach this subject once more. In this manuscript epidemiological data that indicates the magnitude of the problem will be updated. Treatment alternatives to decrease back pain produced by vertebral fracture are will be reviewed, and the prevention of the occurrence of new osteoporotic fractures of any type, through the administration of suitable antiresorptive and bone-forming pharmacological agents to increase bone mineral density will also be addressed. In some patients with painful vertebral compression fractures it is possible obtain an analgesic effect by percutaneous vertebroplasty or by kiphoplasty using polymethylmetacrilate cement or calcium- phosphate cement, injected into vertebral bodies.