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Sequential IV ibandronate tied to BMD increase

Reuters Health - 08/12/2020 - Monthly intravenous ibandronate is associated with increases in bone mineral density (BMD) and bone microstructure benefits in women with osteoporosis after teriparatide treatment, according to new findings.

Once teriparatide treatment is complete, patients will lose the bone they gained while on the medication, so sequential treatment with a bone resorption inhibitor is advised, Dr. Ko Chiba of Nagasaki University Graduate School of Biomedical Sciences and colleagues note in their report. Elderly patients with severe osteoporosis are often treated with ibandronate after teriparatide, they add, but there is not enough evidence supporting the efficacy of this approach.

To investigate, the authors looked at 63 women 55 and older who had taken teriparatide for more than a year, with an average treatment duration of about 19 months. Participants started a year-long regimen of monthly IV ibandronate within two months of stopping teraparatide. They also took vitamin supplements containing 610 mg calcium, 400 IU natural vitamin D and 30 mg magnesium daily.

At one year, levels of tartrate-resistant acid phosphatase-5b (TRACP-5b), a marker of bone resorption, had dropped 39.5% compared with baseline. TRACP-5b levels were in the normal range for 82.3% of participants.

Lumbar spine BMD increased 3.2%, and 79% of participants had a response, with 40.3% having increases of 5% or more. Total hip BMD had increased by 1.2% at one year, and femoral neck BMD increased 1.3%.

Cortical thickness of the distal tibia increased 2.6% and cortical area increased by 2.5%. There was also a 2.5% reduction in buckling ratio, a measure of cortical instability, in the tibia.

Adverse events caused two patients to drop out of the study. One had a recurrence of angina and the other had fever and general pain.

"These results demonstrate the positive effects of sequential therapy with monthly intravenous ibandronate on BMD and cortical bone microstructure," Dr. Chiba and colleagues conclude.

SOURCE: https://bit.ly/2IteCZa Bone, online November 29, 2020.

By Reuters Staff

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