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Denosumab Discontinuation.

Anne Sophie Sølling1,2, Elena Tsourdi3, Torben Harsløf1

  • 1Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark.

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Summary

Discontinuing denosumab (DMAB) causes rapid bone loss and increased fracture risk. Subsequent antiresorptive treatment and close monitoring are crucial after stopping DMAB to mitigate these effects.

Keywords:
Bone mineral densityBone turnover markersDenosumabFractureOsteoporosis

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Area of Science:

  • Endocrinology
  • Bone Biology
  • Pharmacology

Background:

  • Denosumab (DMAB) treatment is reversible, leading to rapid bone turnover and loss upon discontinuation.
  • This rebound effect increases fracture risk, suggesting potential for long-term or lifelong therapy.
  • Discontinuation may be necessary due to side effects or reaching peak bone mineral density (BMD).

Purpose of the Study:

  • To review the pathophysiology of denosumab discontinuation.
  • To examine the clinical consequences, including bone loss and fracture risk.
  • To outline strategies for mitigating the effects of denosumab withdrawal.

Main Methods:

  • Literature review of studies published within the last 1-3 years.
  • Focus on bone turnover markers, bone mineral density (BMD), and fracture risk after denosumab withdrawal.
  • Evaluation of transition strategies to other anti-osteoporosis therapies and international guideline recommendations.

Main Results:

  • Discontinuation of denosumab (DMAB) leads to a rapid increase in bone turnover and significant bone loss.
  • An elevated risk of fractures is observed during the high bone turnover phase post-discontinuation.
  • Subsequent antiresorptive therapy is recommended, with intensive monitoring during the first year to manage bone loss.

Conclusions:

  • Denosumab discontinuation necessitates careful management due to rapid bone loss and increased fracture risk.
  • Transitioning to alternative antiresorptive treatments is recommended for patients stopping denosumab.
  • Close monitoring is essential in the initial year after denosumab withdrawal to prevent adverse skeletal events.