Multiple vertebral fractures following osteoporosis treatment discontinuation: a case-report after long-term Odanacatib.
INTRODUCTION
Case reports of women sustaining multiple vertebral fractures (VF) soon afterdenosumab discontinuation are accumulating.


METHODS
We report a woman with five new vertebral fractures in ~8 months following discontinuation of long-term odanacatib (ODN), an experimental cathepsin K inhibitor.


RESULTS
DXA examination demonstrated an ~12% decline in bone mineral density (BMD) and ~9% decline in trabecular bone score (TBS) since ODN discontinuation. Laboratory evaluation did not reveal a secondary cause of bone loss.


CONCLUSIONS
This case mimics observations following denosumab discontinuation, but, to our knowledge, is the first reported with ODN and the first documenting substantial decline in TBS. While not directly clinically relevant as ODN is no longer being developed, this case raises the possibility that a syndrome of multiple vertebral fractures could follow discontinuation of various potent osteoporosis therapies that produce major BMD increases but do not have persisting bone effects (i.e., all non-bisphosphonates). Use of antiresorptive therapies to prevent rapid bone loss following discontinuation of potent bone active agents seems appropriate. Identification of those patients who could be at risk for the multiple VF syndrome is needed.
['Binkley|N|N|http://orcid.org/0000-0002-9905-461X', 'Krueger|D|D|', 'de Papp|A E|AE|']
D000368:Aged D001713:Biphenyl Compounds D015519:Bone Density D050071:Bone Density Conservation Agents D004334:Drug Administration Schedule D005260:Female D006801:Humans D015663:Osteoporosis, Postmenopausal D058866:Osteoporotic Fractures D011859:Radiography D012008:Recurrence D016103:Spinal Fractures D028761:Withholding Treatment
Vertebral fracture Osteoporosis Odanacatib