Marianne Lamarre1, Martine Marcotte2, Danielle Laurin2,3,4,5,6, Daniela Furrer2, Isabelle Vedel7, André Tourigny1,2,4,5,6, Anik Giguère1,2,5,6, Pierre-Hugues Carmichael2,6, Rosa Martines2, José Morais7, Edeltraut Kröger8,9,10,11,12. 1. Faculté de médecine, Université Laval, Quebec City, Quebec, Canada. 2. Centre d'excellence sur le vieillissement de Québec, CIUSSS Capitale Nationale, Quebec City, Quebec, Canada. 3. Faculté de pharmacie, Université Laval, Quebec City, Quebec, Canada. 4. Institut sur le vieillissement et la participation sociale des aînés de l, Université Laval, Quebec City, Quebec, Canada. 5. Centre de recherche du CHU de Québec, Université Laval, Quebec City, Quebec, Canada. 6. VITAM Centre de recherche sur la santé durable, Quebec City, Quebec, Canada. 7. Faculty of Medicine, McGill University, Montreal, Quebec, Canada. 8. Centre d'excellence sur le vieillissement de Québec, CIUSSS Capitale Nationale, Quebec City, Quebec, Canada. edeltraut.kroger.ciussscn@ssss.gouv.qc.ca. 9. Faculté de pharmacie, Université Laval, Quebec City, Quebec, Canada. edeltraut.kroger.ciussscn@ssss.gouv.qc.ca. 10. Centre de recherche du CHU de Québec, Université Laval, Quebec City, Quebec, Canada. edeltraut.kroger.ciussscn@ssss.gouv.qc.ca. 11. VITAM Centre de recherche sur la santé durable, Quebec City, Quebec, Canada. edeltraut.kroger.ciussscn@ssss.gouv.qc.ca. 12. Faculty of Medicine, McGill University, Montreal, Quebec, Canada. edeltraut.kroger.ciussscn@ssss.gouv.qc.ca.
Abstract
PURPOSE: Bisphosphonates are used to treat osteoporosis. Despite their benefits on bone mineral density (BMD) and fractures, they have shown adverse effects, sometimes severe, during chronic use. Taken for several years, they achieve long-term bone retention, making deprescribing feasible. This review aimed to synthesize evidence on the success and health outcomes of deprescribing of bisphosphonates in seniors, aged over 60 years. METHODS: The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, including articles in English, French, or German published before July 2020. Eligible studies included seniors having discontinued bisphosphonates and reported on health outcomes; some allowed meta-analyses on fracture risk. RESULTS: The review included 9 RCTs and 9 cohort studies of moderate quality. Bisphosphonates were discontinued after 2 to 7 years of use, and BMD or fractures were assessed during follow-up of 0.5 to 5 years. A significant reduction in BMD after discontinuation was observed in 9 of 10 studies. Results on fracture risk after discontinuation are mitigated: 6 RCT extensions showed no increase in the risk of any osteoporotic fractures after discontinuation. Meta-analyses including 4 RCTs showed an increased odds ratio of vertebral fractures of 2.04 (95% CI, 1.39-2.99) among discontinuers. Results from 2 large cohort studies showed no increased risks of any osteoporotic or vertebral fractures, while 2 studies found increased fracture risks. CONCLUSION: Bisphosphonates have successfully been discontinued low overall fracture risk after at least 3 years of use, but a risk for decreased BMD and increased vertebral fractures remained.
PURPOSE: Bisphosphonates are used to treat osteoporosis. Despite their benefits on bone mineral density (BMD) and fractures, they have shown adverse effects, sometimes severe, during chronic use. Taken for several years, they achieve long-term bone retention, making deprescribing feasible. This review aimed to synthesize evidence on the success and health outcomes of deprescribing of bisphosphonates in seniors, aged over 60 years. METHODS: The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, including articles in English, French, or German published before July 2020. Eligible studies included seniors having discontinued bisphosphonates and reported on health outcomes; some allowed meta-analyses on fracture risk. RESULTS: The review included 9 RCTs and 9 cohort studies of moderate quality. Bisphosphonates were discontinued after 2 to 7 years of use, and BMD or fractures were assessed during follow-up of 0.5 to 5 years. A significant reduction in BMD after discontinuation was observed in 9 of 10 studies. Results on fracture risk after discontinuation are mitigated: 6 RCT extensions showed no increase in the risk of any osteoporotic fractures after discontinuation. Meta-analyses including 4 RCTs showed an increased odds ratio of vertebral fractures of 2.04 (95% CI, 1.39-2.99) among discontinuers. Results from 2 large cohort studies showed no increased risks of any osteoporotic or vertebral fractures, while 2 studies found increased fracture risks. CONCLUSION: Bisphosphonates have successfully been discontinued low overall fracture risk after at least 3 years of use, but a risk for decreased BMD and increased vertebral fractures remained.
Authors: Laura Y Park-Wyllie; Muhammad M Mamdani; David N Juurlink; Gillian A Hawker; Nadia Gunraj; Peter C Austin; Daniel B Whelan; Peter J Weiler; Andreas Laupacis Journal: JAMA Date: 2011-02-23 Impact factor: 56.272
Authors: Dennis M Black; Ann V Schwartz; Kristine E Ensrud; Jane A Cauley; Silvina Levis; Sara A Quandt; Suzanne Satterfield; Robert B Wallace; Douglas C Bauer; Lisa Palermo; Lois E Wehren; Antonio Lombardi; Arthur C Santora; Steven R Cummings Journal: JAMA Date: 2006-12-27 Impact factor: 56.272
Authors: Panagiotis Anagnostis; Stavroula A Paschou; Gesthimani Mintziori; Iuliana Ceausu; Herman Depypere; Irene Lambrinoudaki; Alfred Mueck; Faustino R Pérez-López; Margaret Rees; Levent M Senturk; Tommaso Simoncini; John C Stevenson; Petra Stute; Florence A Trémollieres; Dimitrios G Goulis Journal: Maturitas Date: 2017-04-15 Impact factor: 4.342
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Authors: Giovanni Adami; Ayesha Jaleel; Jeffrey R Curtis; Elizabeth Delzell; Rui Chen; Huifeng Yun; Shanette Daigle; Tarun Arora; Maria I Danila; Nicole C Wright; Suzanne M Cadarette; Amy Mudano; Jeffrey Foster; Kenneth G Saag Journal: J Bone Miner Res Date: 2019-12-10 Impact factor: 6.741