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Title: Risk factors for prediction of inadequate response to antiresorptives
Authors: Díez-Pérez, Adolfo
Olmos, Jose M.
Nogués, Xavier
Sosa, Manuel 
Díaz-Curiel, Manuel
Pérez-Castrillón, Jose Luis
Pérez-Cano, Ramon
Muñoz-Torres, Manuel
Torrijos, Antonio
Jodar, Esteban
Del Rio, Luis
Caeiro-Rey, Jose R.
Farrerons, Jordi
Vila, Joan
Arnaud, Claude
González-Macías, Jesus
Keywords: Bone-Mineral Density
Vertebral Fracture Risk
Postmenopausal Women
Osteoporosis Therapy
Bisphosphonate Therapy, et al
Issue Date: 2012
Publisher: 0884-0431
Journal: Journal of Bone and Mineral Research 
Abstract: Some patients sustain fractures while on antiresorptives. Whether this represents an inadequate response (IR) to treatment or a chance event has not been elucidated. We performed a study to identify which patients are more likely to fracture while on treatment. This is a multicentric, cross-sectional study of postmenopausal women on antiresorptives for osteoporosis in 12 Spanish hospitals, classified as adequate responders (ARs) if on treatment with antiresorptives for 5 years with no incident fractures or inadequate responders (IRs) if an incident fracture occurred between 1 and 5 years on treatment. Poor compliance, secondary osteoporosis, and previous anti-osteoporosis treatment other than the assessed were exclusion criteria. Clinical, demographic, analytical, dual-energy X-ray absorptiometry (DXA) variables, and proximal femur structure analysis (Ima(TM)) and structural/fractal analyses of distal radius were performed. A total of 179 women (76 IRs; mean (SD): age 68.2 (9.0) years; 103 ARs, age 68.5 (7.9) years) were included. History of prior fracture (p=0.005), two or more falls in the previous year (p=0.032), low lumbar spine bone mineral density (BMD) (p=0.02), 25 hydroxyvitamin D (p=0.017), and hip ImaTx fracture load index (p=0.004) were associated with IR. In the logistic regression models a fracture before treatment (odds ratio [OR], 3.60; 95% confidence interval [CI], 1.47-8.82; p=0.005) and levels of 25 hydroxyvitamin D below 20 ng/mL (OR, 3.89; 95% CI, 1.55-9.77; p=0.004) significantly increased risk for IR, while increased ImaTx fracture load (OR, 0.96; 95% CI, 0.93-0.99; p = 0.006; per every 100 units) was protective, although the latter became not significant when all three variables were fitted into the model. Therefore, we can infer that severity of the disease, with microarchitectural and structure deterioration, as shown by previous fracture and hip analysis, and low levels of 25 hydroxy vitamin D carry higher risk of inadequate response to antiresorptives. More potent regimes should be developed and adequate supplementation implemented to solve this problem. (c) 2012 American Society for Bone and Mineral Research.
ISSN: 0884-0431
DOI: 10.1002/jbmr.1496
Source: Journal of Bone and Mineral Research[ISSN 0884-0431],v. 27, p. 817-824
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