Magnetic resonance imaging has an advantage over conventional spine X-rays in the evaluation of rebound-associated verte
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CLINICAL MANAGEMENT OF ENDOCRINE DISEASES
Magnetic resonance imaging has an advantage over conventional spine X-rays in the evaluation of rebound-associated vertebral fractures following denosumab discontinuation Athanasios D. Anastasilakis
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Gerasimos Evangelatos2 Polyzois Makras3 Alexios Iliopoulos2 ●
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Received: 29 March 2020 / Accepted: 25 April 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Introduction Patients discontinuing or neglecting denosumab treatment are at risk of sustaining rebound-associated vertebral fractures (RAVFs). In everyday clinical practice, conventional X-rays are used to diagnose such events in patients reporting acute back pain. Patients Herein we report the cases of two patients, in whom magnetic resonance imaging (MRI) depicted more RAVFs or allowed earlier detection of RAVFs compared with conventional X-rays. Conclusion It seems that, in the setting of RAVFs following denosumab discontinuation, MRI imaging provides better accuracy in the diagnostic process and in the classification assessment compared to conventional X-rays, thus allowing an earlier and clearer picture of the magnitude of spinal damage. This could have an impact on clinical decisions and improve patient’s management. Keywords Denosumab Discontinuation Fracture Rebound Osteoporosis ●
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Introduction Conventional lateral X-rays of the thoracolumbar spine represent the standard imaging method used routinely in everyday clinical practice to identify the presence of vertebral fractures, both during the screening for osteoporosis as well as when a patient reports acute back pain. Among proposed morphometric evaluation systems, the semiquantitative approach has demonstrated the best sensitivity and specificity, and is currently considered as the diagnostic gold standard [1, 2]. However, underdiagnosis of osteoporotic vertebral fractures due to lack of radiographic detection could occur [3]. In the last decades, magnetic resonance imaging (MRI) represents an alternative method
* Athanasios D. Anastasilakis [email protected]
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of spine imaging. MRI, although considerably more expensive, provides better visualization of the vertebrae involved, early diagnosis, and superior accuracy in the classification assessment [4]. Denosumab is a potent antiresorptive agent, continuously increasing bone mineral density (BMD) and decreasing fractures at all skeletal sites for as long as it is administered [5, 6]. However, denosumab discontinuation results in a rapid, profound increase of bone resorption [7], which in a proportion of patients may lead to rebound-associated multiple vertebral fractures (RAVFs) [8, 9]. We herein report cases of patients from the everyday clinical practice, in whom MRI either depicted more RAVFs or allowed earlier detection of RAVFs compared with conventional X-rays following denosumab discontinuation. Informed consent was obtained from the patients for publication of their case reports and accompanying images.
Cases
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