Risks vs. benefits of switching therapy in patients with postmenopausal osteoporosis

ABSTRACT

Introduction: Osteoporosis is characterized by the fragility of bones, leading to fractures and, consequently, the deterioration of functional capacity and quality of life. Postmenopausal women, in particular, are prone to osteoporosis and often require anti-osteoporosis treatment. In the last few decades, various anti-osteoporosis drugs have been approved for clinical use. In an aging society, osteoporosis cannot be treated using a single agent; therefore, switching therapy is an important treatment strategy.

Areas covered: This review covers switching therapy in patients with postmenopausal osteoporosis. It’s extremely important to understand the characteristics of each drug including; limitations on the duration of use, side effects due to long-term use (such as atypical femur fracture and osteonecrosis of the jaw) or discontinuation (such as rebound phenomenon), compliance, and ability to prevent fractures. We review and summarize the risks and benefits of switching therapy.

Expert opinion: When switching therapy, the order of drug administration is important. Routine monitoring should be continued after switching treatments. We recommend first using osteoanabolic agents in postmenopausal women with severe osteoporosis. In addition, identifying predictors of the efficacy and side effects of treatment may help prevent the inappropriate use of drugs for the treatment of osteoporosis.

KEYWORDS:

• Bisphosphonates
• denosumab
• discontinuation
• osteoporosis
• rebound
• romosozumab
• selective estrogen receptor modulator
• switching therapy
• teriparatide

Acknowledgments

We would like to thank Editage (www.editage.com) for English language editing.

Article highlights

• Switching therapy is an important strategy to limit the duration of use of a single agent, reduce side effects caused by long-term use or discontinuation, improve compliance, and maximize fracture prevention.

• It is important to consider switching therapies from antiresorptive agents, because of elevation risk of rebound-associated vertebral fractures after the discontinuation.

• Switching from Denosumab to Teriparatide therapy is associated with a critical reduction in bone mineral density, therefore, should be avoided.

• Overall, the outcomes of switching therapy from Romosozumab to antiresorptive agents have been found to be positive.

• At the time of switching therapy, it is also important to predict the effectiveness of the future treatment options.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This study was funded by Grant-in-Aid for Young Scientists from the Ministry of Education, Culture, Sports, Science, and Technology of Japan 20K17948 (T. Shimizu).