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Stopping Denosumab

  • Therapeutics and Medical Management (S Jan de Beur and B Clarke, Section Editors)
  • Published:
Current Osteoporosis Reports Aims and scope Submit manuscript

A Correction to this article was published on 31 January 2020

This article has been updated

Abstract

Purpose of Review

Denosumab discontinuation is associated with a rebound effect manifesting by an increased risk of multiple spontaneous vertebral fractures. The purpose of this review is to (1) better characterize this risk and (2) find solutions to avoid it.

Recent Findings

In the absence of a potent bisphosphonate prescription at denosumab discontinuation, the frequency of multiple vertebral fractures is common or frequent (≥ 1/100 and < 1/10). In five recent case series, the median number of vertebral fractures was 5 within 7 to 20 months (median 11) after the last denosumab injection. Prescribing bisphosphonate before starting denosumab and/or after stopping denosumab may reduce this risk. However, only small case series have evaluated these strategies.

Summary

After the second denosumab dose, there is a rebound effect with an increased risk of multiple vertebral fractures. A potent bisphosphonate prescribed at denosumab discontinuation could reduce this risk. As denosumab discontinuation is characterized by many uncertainties, denosumab is a second-line treatment for osteoporosis. Studies are urgently needed to define the management of denosumab discontinuation.

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Change history

  • 31 January 2020

    The author Elena Gonzalez Rodriguez is not properly referenced in PubMed. The reference shows as “Rodriguez E.G.”, but should be “Gonzalez Rodriguez E.”.

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Author information

Authors and Affiliations

  1. Center of Bone Diseases, Lausanne University Hospital, Lausanne, Switzerland

    Olivier Lamy, Delphine Stoll, Bérengère Aubry-Rozier & Elena Gonzalez Rodriguez

  2. Service of Internal Medicine, CHUV, Lausanne University Hospital, Rue du Bugnon 46, CH-1011, Lausanne, Switzerland

    Olivier Lamy

  3. Service of Rheumatology, Lausanne University Hospital, Lausanne, Switzerland

    Bérengère Aubry-Rozier

  4. Service of Endocrinology, Diabetes and Metabolism, Lausanne University Hospital, Lausanne, Switzerland

    Elena Gonzalez Rodriguez

Authors
  1. Olivier Lamy
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  2. Delphine Stoll
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  3. Bérengère Aubry-Rozier
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  4. Elena Gonzalez Rodriguez
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Correspondence to Olivier Lamy.

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Olivier Lamy, Delphine Stoll, Bérengère Aubry-Rozier, and Elena Gonzalez Rodriguez declare that they have no conflict of interest.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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Lamy, O., Stoll, D., Aubry-Rozier, B. et al. Stopping Denosumab. Curr Osteoporos Rep 17, 8–15 (2019). https://doi.org/10.1007/s11914-019-00502-4

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  • DOI: https://doi.org/10.1007/s11914-019-00502-4

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