Bone Mineral Density After Transitioning From Denosumab to Alendronate.
J Clin Endocrinol Metab. 2019 Oct 26;: Authors: Kendler D, Chines A, Clark P, Ebeling PR, McClung M, Rhee Y, Huang S, Stad RK
CONTEXT: There are few studies on subjects transitioning from denosumab to bisphosphonates. OBJECTIVE: To investigate subject characteristics and changes in bone mineral density (BMD) after transitioning from denosumab to alendronate. DESIGN: Randomized, open-label, 2-year crossover Denosumab Adherence Preference Satisfaction (DAPS) study (NCT00518531). SETTING: 25 study centers in the USA and Canada. PATIENTS: Treatment-naïve postmenopausal women with BMD T-scores ≤-2.0 to ≥-4.0. INTERVENTIONS: This post hoc analysis evaluated subjects randomized to denosumab 60 mg SC Q6M in year 1 followed by alendronate 70 mg QW PO in year 2. MAIN OUTCOME MEASURE: A 3% BMD threshold identified subjects who lost, maintained, or gained BMD in year 2 on alendronate. RESULTS: Of 126 subjects randomized to denosumab, 115 (91%) transitioned to alendronate in year 2. BMD increased by 3%-6% with denosumab in year 1 and by 0%-1% with alendronate in year 2. After transitioning to alendronate, most subjects maintained or increased BMD; 15.9%, 7.6%, and 21.7% lost BMD at the lumbar spine, total hip, and femoral neck, respectively. Few subjects fell below their pretreatment baseline BMD value; this occurred most often in those who lost BMD in year 2. Subjects who lost BMD with alendronate in year 2 also showed a greater percent change in BMD with denosumab in year 1. The BMD change in year 2 was similar regardless of baseline characteristics or adherence to oral alendronate. CONCLUSION: Alendronate can effectively maintain the BMD gains accrued after 1 year of denosumab in most subjects, regardless of baseline characteristics. PMID: 31665314 [PubMed - as supplied by publisher]