Commentary to “Denosumab for bone health in prostate and breast cancer patients receiving endocrine therapy? A systematic review and a meta-analysis of randomized trials” (Galvano et al. J Bone Oncol 2019; 18:100252)
Abstract
We read with great interest the systematic review and a meta-analysis of randomized trials on denosumab for bone health in cancer patients receiving endocrine therapy by Galvano A. et al. [1]. We disagree with the main conclusion of this review article, which is that denosumab administration can be considered effective and safe in this clinical situation. In prostate cancer patients receiving androgen deprivation therapy, and in patients under adjuvant endocrine therapy for early-stage endocrine-sensitive breast cancer, denosumab is routinely discontinued when the hormonal treatment is interrupted, unless a diagnosis of osteoporosis persists. It is now well known that denosumab discontinuation is associated with a severe rebound effect that lasts 2 years, which combines an increase in bone turnover markers and a complete loss of the gained bone density [2]. This rebound effect is associated, in postmenopausal osteoporosis, with multiple spontaneous vertebral fractures (MSVF) as described in several case series and in the post-hoc follow-up of the pivotal FREEDOM trial [3–7]. Cases have also been described in men [8]. It is a severe secondary effect, as patients present a median of five (1–11) vertebral fractures 7–20 months (median 11) after the last denosumab injection [7]. 1–10% of women with post-menopausal osteoporosis discontinuing denosumab suffer of MSVF, and although bisphosphonates given at denosumab discontinuation probably decrease the MVSF risk, cases of fracture…
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Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 15 participants or records.
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