Romosozumab after rebound vertebral fractures induced by denosumab discontinuation: a case series

Discontinuation of denosumab can lead to a rebound increase in bone resorption, which may result in multiple vertebral fractures. Current guidelines recommend retreatment with denosumab or administration of zoledronate in this setting.

We report a series of 4 patients who developed vertebral fractures following denosumab withdrawal and were subsequently treated with romosozumab, a dual-action agent with anabolic and antiresorptive properties.

All patients showed progressive improvement in BMD and microarchitecture, with suppression of bone turnover markers and no new clinical fractures during treatment and follow-up.

Although limited by the uncontrolled design and small sample size, these observations suggest that romosozumab might be considered as a potential therapeutic approach for selected patients with post-denosumab rebound fractures.