[Multiple Vertebral Fractures after Denosumab Discontinuation: How to Avoid Them?]
Olivier Lamy1, Elena Gonzalez Rodriguez2, Delphine Stoll3
11 Service de Médecine Interne et Centre des Maladies Osseuses, Départements de Médecine et de l'Appareil Locomoteur - CHUV, Lausanne.
Praxis
|June 7, 2018
Summary
Discontinuing denosumab can lead to a rebound effect, increasing vertebral fracture risk. Switching to bisphosphonates and monitoring bone resorption markers can help mitigate this risk.
Area of Science:
- Endocrinology
- Rheumatology
- Orthopedics
Background:
- Denosumab, a monoclonal antibody targeting RANK ligand, effectively reduces bone resorption and fracture risk.
- Discontinuation of denosumab can trigger a significant rebound effect, characterized by increased bone remodeling.
- This rebound phenomenon poses a substantial risk of multiple vertebral fractures.
Purpose of the Study:
- To investigate the mechanisms and risks associated with denosumab discontinuation.
- To explore strategies for mitigating the rebound effect and preventing associated vertebral fractures.
- To establish optimal management guidelines following denosumab cessation.
Main Methods:
- Review of existing literature on denosumab's mechanism of action and clinical effects.
- Analysis of post-discontinuation bone remodeling markers and fracture incidence data.
- Evaluation of current recommendations for managing denosumab cessation.
Main Results:
- Denosumab discontinuation leads to a pronounced rebound in bone remodeling markers lasting up to two years.
- A significant increase in vertebral fracture risk, occurring in 1-10% of patients, is observed post-discontinuation.
- Denosumab's use is recommended as a second-line therapy for specific indications due to this risk.
Conclusions:
- Denosumab discontinuation necessitates careful management to prevent rebound-associated vertebral fractures.
- Prescribing potent bisphosphonates (e.g., alendronate, zoledronate) upon cessation is a recommended strategy.
- Regular monitoring of bone resorption markers is crucial for managing patients after denosumab discontinuation.
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