title: Risk factors for prediction of inadequate response to antiresorptives.
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 (ImaTx™) 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.
authors.affiliation: Hospital del Mar-IMIM-UAB, Department of Internal Medicine, Barcelona, Spain. ADiez@hospitaldelmar.cat
authors.forename: Adolfo
authors.initials: A
authors.lastname: Díez-Pérez
authors.forename: Jose M
authors.initials: JM
authors.lastname: Olmos
authors.forename: Xavier
authors.initials: X
authors.lastname: Nogués
authors.forename: Manuel
authors.initials: M
authors.lastname: Sosa
authors.forename: Manuel
authors.initials: M
authors.lastname: Díaz-Curiel
authors.forename: Jose Luis
authors.initials: JL
authors.lastname: Pérez-Castrillón
authors.forename: Ramon
authors.initials: R
authors.lastname: Pérez-Cano
authors.forename: Manuel
authors.initials: M
authors.lastname: Muñoz-Torres
authors.forename: Antonio
authors.initials: A
authors.lastname: Torrijos
authors.forename: Esteban
authors.initials: E
authors.lastname: Jodar
authors.forename: Luis
authors.initials: L
authors.lastname: Del Rio
authors.forename: Jose R
authors.initials: JR
authors.lastname: Caeiro-Rey
authors.forename: Jordi
authors.initials: J
authors.lastname: Farrerons
authors.forename: Joan
authors.initials: J
authors.lastname: Vila
authors.forename: Claude
authors.initials: C
authors.lastname: Arnaud
authors.forename: Jesus
authors.initials: J
authors.lastname: González-Macías
mesh_terms: D000368:Aged; D050071:Bone Density Conservation Agents / Q000009:adverse effects / Q000627:therapeutic use*; D016022:Case-Control Studies; D005260:Female; D050723:Fractures, Bone / Q000139:chemically induced; D006801:Humans; D016015:Logistic Models; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D050071:Bone Density Conservation Agents