Rebound-associated vertebral fractures may occur in sequential time points following denosumab discontinuation: need for prompt treatment re-initiation

Abstract

Denosumab discontinuation has been associated with increased risk of rebound-associated multiple vertebral fractures. We report the cases of three patients, two females and one male, who had manifested rebound-associated vertebral fractures after denosumab discontinuation and sustained new vertebral fractures a few months later. Two of the patients had been previously treated with bisphosphonates. Patients discontinued denosumab after 2 to 8 years of treatment. One of the female patients was receiving prednisolone 7.5 mg daily for an unspecified connective tissue disorder and the male patient methylprednisolone 8 mg daily for dermatomyositis. We hypothesize that rebound-associated multiple vertebral fractures after denosumab discontinuation may occur, at least in some cases, sequentially instead of simultaneously. Our cases further underpin the need for prompt initiation of potent antiresorptives in patients who sustained rebound-associated vertebral fractures, in order to prevent not only bone loss but also a second round of fractures.

Keywords: Denosumab; Discontinuation; Fracture; Osteoporosis; Rebound.

Fig. 1

Magnetic resonance imaging of the spine (Panel A) and X-rays (Panel B) depicting the fracture at T11 in Patient 1. X-Rays showing the new fracture at L3 in Patient 1 (Panel C). Computed Tomography of the spine showing the multiple vertebral fractures in patient 2 (Panel D). X-rays depicting the first timepoint fracture at L1 (Panel E) and the additional fractures at L2, L3, L4, and L5 at the second timepoint in patient 3 (Panel F).