Denosumab for osteoporosis treatment: when, how, for whom, and for how long. A pragmatical approach
Abstract
Denosumab produces a continuous increase in bone mineral density over ten years, associated with a low risk of vertebral and non-vertebral fractures. Denosumab is well tolerated and easy to manage in daily clinical practice. For all these reasons, this treatment has a huge success. On the other hand, discontinuation of treatment is associated with a severe rebound effect including a sharp increase in bone turnover markers, loss of the bone density gained and a risk of nearly 20% of multiple vertebral fractures in postmenopausal women. High doses of potent bisphosphonates are needed to maintain bone turnover markers in the low range of premenopausal women, to mitigate this rebound effect. Prolonged treatment with denosumab is associated with a greater rebound effect and increases the risk of an early rebound effect. The occurrence of rare side effects such as osteonecrosis of the jaw or atypical femoral fracture, as well as the onset of severe renal failure, leave clinicians at a therapeutic impasse. Continuing denosumab or switching to bisphosphonates remains suboptimal and, currently, no evidence clarifies the optimal treatment approach for these patients. The aim of this review is to give a very practical clinical approach to the use of denosumab (duration of treatment), and to the management of rebound effect and possible adverse effects.
Read the paper
Related studies
- Vitamin D supplementation for improving bone density in vitamin D-deficient children and adolescents: systematic review and individual participant data meta-analysis of randomized controlled trials
- Calcium supplementation during pregnancy and maternal and offspring bone health: a systematic review and meta-analysis
- Change in CT-measured acetabular bone density following total hip arthroplasty: a systematic review and meta-analysis
- Bisphosphonate therapy for osteogenesis imperfecta
- Bisphosphonate therapy for osteogenesis imperfecta
- Exposure to per- and polyfluoroalkyl substances and bone health: a systematic review and meta-analysis
Go deeper in Evidence Hub
Evidence Hub adds a study data sheet (design, sample size, evidence level, key numbers), an AI summary and a chat grounded in the paper's text.