Stopping osteoporosis treatment may increase fracture risk in post-menopausal women

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Post-menopausal osteoporosis is a condition where bones become weak and brittle due to decreased bone mineral density.

This condition is particularly common in women after menopause because of the drop in estrogen levels, which affects bone health. With an aging population, osteoporosis is a growing health issue.

Bisphosphonates are the first-choice treatment for post-menopausal osteoporosis. Denosumab is a second-line treatment.

These drugs are typically prescribed for 3-5 years, but recent guidelines suggest stopping treatment after this period for many patients. However, there are concerns about the risks of stopping these medications.

New data presented at the 2024 EULAR congress in Vienna sheds light on the risks associated with stopping osteoporosis treatments.

A large study in France examined over 128,000 women using the national health database. The study looked at the incidence of stopping bisphosphonates and denosumab, and the impact on fracture risk.

Key Findings

  • Treatment Discontinuation: Many women stop their osteoporosis treatment. Specifically, 55.1% of those on oral bisphosphonates, 68.9% on intravenous bisphosphonates, and 42.5% on denosumab had long-term discontinuations, usually occurring in their mid-to-late 70s after about 3.7–4.8 years of treatment.
  • Increased Fracture Risk: Stopping these treatments significantly increased the risk of fractures. Women who stopped bisphosphonates had a 12.4% higher risk of fragility fractures, while those who stopped denosumab had a 92.3% higher risk. The risk was higher for most types of fractures, especially hip fractures, which increased by 19% for bisphosphonates and 108.3% for denosumab.
  • Comparison of Treatment Types: The study found differences in fracture risk based on the type of bisphosphonate. Oral bisphosphonates had a notable increase in fracture risk, while intravenous bisphosphonates did not show significant differences in fracture risk compared to continuous treatment.

These findings highlight the potential dangers of stopping osteoporosis treatment, particularly denosumab, which is not recommended to be discontinued.

The high percentage of women who stopped treatment and the subsequent increase in fracture risk suggest a need for better management strategies.

Doctors and patients should carefully consider the risks before stopping osteoporosis treatments. Further research is needed to understand why different types of bisphosphonates have different impacts on fracture risk. This could lead to improved guidelines and better patient outcomes.

In summary, while stopping osteoporosis treatments like bisphosphonates and denosumab is common, it significantly increases the risk of fractures, especially hip fractures. Continuous treatment may be crucial for maintaining bone health and preventing fractures in post-menopausal women.

If you care about bone health, please read studies about vitamin K deficiency linked to hip fractures in old people, and these vitamins could help reduce bone fracture risk.

For more information about wellness, please see recent studies that Krill oil could improve muscle health in older people, and eating yogurt linked to lower frailty in older people.