[Denosumab in clinical practice : beware before, during and after]
Olivier Lamy1,2, Elena Gonzalez-Rodriguez2,3, Delphine Stoll2,4
1Service de médecine interne, CHUV, 1011 Lausanne.
Revue Medicale Suisse
|July 21, 2017
Summary
Denosumab effectively treats osteoporosis but requires careful monitoring due to risks. Stopping denosumab can cause a severe rebound effect, which potent bisphosphonates can mitigate.
Area of Science:
- Endocrinology
- Bone Metabolism
- Pharmacology
Background:
- Denosumab is a highly effective osteoporosis treatment, known for ease of use and good tolerability.
- Despite its benefits, denosumab carries associated risks necessitating close clinical supervision.
- Pre-treatment correction of hypocalcemia and vitamin D deficiency is crucial.
Purpose of the Study:
- To outline the clinical management and monitoring requirements for denosumab therapy.
- To detail the risks associated with denosumab discontinuation, specifically the rebound effect.
- To present strategies for mitigating the rebound effect upon cessation of denosumab treatment.
Main Methods:
- Review of clinical guidelines and pharmacological data regarding denosumab.
- Analysis of bone remodeling markers and bone mineral density changes post-denosumab discontinuation.
- Evaluation of bisphosphonate efficacy in preventing denosumab rebound.
Main Results:
- Denosumab requires scrupulous administration every six months (± 3 weeks).
- Close monitoring of calcemia is essential, particularly in patients with renal insufficiency.
- Discontinuation leads to a significant rebound effect, including increased bone remodeling, decreased bone density, and fracture risk.
Conclusions:
- Careful patient selection and monitoring are essential for safe and effective denosumab use.
- The severe rebound effect following denosumab cessation necessitates proactive management.
- Administering potent bisphosphonates like zoledronate or alendronate effectively minimizes or prevents the rebound effect.
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