Zoledronic acid maintains BMD gains after teriparatide, deno
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Following short-term therapy with teriparatide plus denosumab with a single dose of zoledronic acid may prevent bone loss associated with denosumab cessation among postmenopausal women, according to a study published in the Journal of Bone and Mineral Research.

Combined teriparatide and denosumab rapidly and substantially increases bone mineral density (BMD) at all anatomic sites. Discontinuation of denosumab however, results in high-turnover bone loss and increased fracture risk. The optimal way to prevent this bone loss remains undefined.

This study is a preplanned extension of the DATA-HD study, where postmenopausal women with osteoporosis were randomized to receive 9 months of either 20 µg or 40 µg of teriparatide daily overlapping with denosumab (60 mg administered at months 3 and 9). At the completion of this 15 month study, women were invited to enroll in the DATA-HD Extension where they received a single dose of zoledronic acid (5 mg) 24 to 35 weeks after the last denosumab dose.

Areal BMD and bone turnover markers were measured at month 27 and 42 (12 and 27 months after zoledronic acid, respectively) and spine and hip volumetric bone density by quantitative CT was measured at month 42. Fifty-three women enrolled in the DATA-HD Extension. At the femoral neck and total hip, the mean 5.6% and 5.1% gains in BMD achieved from month 0 to 15 were maintained both 12 and 27 months after zoledronic acid administration. At the spine, the mean 13.6% gain in BMD achieved from month 0 to 15 was maintained for the first 12 months but modestly decreased thereafter, resulting in a 3.0% reduction 27 months after zoledronic acid.

The pattern of BMD changes between months 15 and 42 were qualitatively similar in the 20 µg and 40 µg groups. A single dose of zoledronic acid effectively maintains the large and rapid total hip and femoral neck BMD increases achieved with combination teriparatide/denosumab therapy for at least 27 months following the transition. Spine BMD was also largely, though not fully, maintained during this period. These data suggest that the DATA-HD Extension regimen may be an effective strategy in the long-term management of patients at high risk of fragility fracture.

Source: https://asbmr.onlinelibrary.wiley.com/doi/abs/10.1002/jbmr.4259
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