Discontinuation of bisphosphonates in seniors: a systematic review on health outcomes
| Autor: | André Tourigny, Danielle Laurin, Isabelle Vedel, Anik Giguère, Martine Marcotte, Pierre-Hugues Carmichael, Marianne Lamarre, Rosa Martines, Edeltraut Kröger, Daniela Furrer, José A. Morais |
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| Rok vydání: | 2021 |
| Předmět: |
Pediatrics
medicine.medical_specialty Osteoporosis 030209 endocrinology & metabolism law.invention 03 medical and health sciences 0302 clinical medicine Randomized controlled trial Bone Density law Outcome Assessment Health Care Humans Medicine Orthopedics and Sports Medicine 030212 general & internal medicine Adverse effect Aged Bone Density Conservation Agents Diphosphonates business.industry Odds ratio medicine.disease 3. Good health Discontinuation Systematic review Deprescribing business Osteoporotic Fractures Cohort study |
| Zdroj: | Archives of Osteoporosis. 16 |
| ISSN: | 1862-3514 1862-3522 |
| DOI: | 10.1007/s11657-021-01000-w |
| Popis: | 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. 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. 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. 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. |
| Databáze: | OpenAIRE |
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