Fracturas vertebrales múltiples tras la suspensión de tratamiento con denosumab: serie de diez casos

espanolObjetivos Analizar las caracteristicas clinicas y de metabolismo oseo de una serie de pacientes con fracturas vertebrales tras la suspension de denosumab (DMab). Metodos Estudio observacional retrospectivo de 10 pacientes con fracturas vertebrales tras suspender DMab atendidas en el Servicio de Reumatologia de un hospital espanol de tercer nivel entre 2015 y 2018. Resultados Se registraron un total de 49 fracturas espontaneas tras una media de 6 dosis de DMab y transcurridos 10,9 meses desde la suspension del farmaco. El 90% habia recibido tratamiento previo, 7 de 10 bisfosfonatos orales. Tras la suspension, CTX y P1NP estaban elevados y la media de T-score en cuello femoral y columna lumbar fue menor que previo a DMab. Las vertebras mas afectadas fueron L3, L5, D6, D7, D9 y D11. Conclusion La descripcion de nuevos casos de fracturas vertebrales multiples en los meses posteriores a la suspension de DMab subraya la preocupacion emergente en la comunidad cientifica siendo preciso apoyar en evidencias solidas las nuevas recomendaciones sobre su manejo. EnglishObjectives 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.