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Review
. 2021 Apr 22:12:20420188211010052.
doi: 10.1177/20420188211010052. eCollection 2021.

Should denosumab treatment for osteoporosis be continued indefinitely?

Jane A Noble  1 , Malachi J McKenna  2 , Rachel K Crowley  3
Affiliations
Review

Should denosumab treatment for osteoporosis be continued indefinitely?

Jane A Noble et al. Ther Adv Endocrinol Metab. .

Abstract

Denosumab was approved for the treatment of postmenopausal osteoporosis in 2010, based on the FREEDOM study, which indicated a benefit in terms of increased bone mineral density and reduced risk of major osteoporotic fracture. In the initial clinical studies it was noted that discontinuation of denosumab can lead to a rebound of bone turnover markers and loss of accrued bone mineral density. An increased risk of fractures (multiple vertebral fractures in particular) associated with discontinuation was noted after approval and marketing of denosumab. For many patients experiencing gain in bone mineral density and fracture prevention while taking denosumab, there is no reason to stop therapy. However, discontinuation of denosumab may happen due to non-adherence; potential lack of efficacy in an individual; where reimbursement for therapy is limited to those with bone mineral density in the osteoporosis range, when assessment reveals this has been exceeded; or patient or physician concern regarding side effects. This review paper aims to discuss these concerns and to summarize the data available to date regarding sequential osteoporosis therapy following denosumab cessation to reduce the risk of multiple vertebral fracture.

Keywords: atypical femoral fracture; denosumab; denosumab cessation; multiple vertebral fractures; osteonecrosis; osteoporosis.

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Conflict of interest statement

Conflict of interest statement: MJM received fees for lectures or advice from: Amgen, Clonmel Healthcare, Mylan, Pharmacosmos, and UCB. RKC received travel support from Amgen.

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