Denosumab Therapy Beyond 10 Years: Subsequent Treatment and Densitometric Outcomes

Area of Science:

• Endocrinology
• Bone Metabolism
• Pharmacology

Background:

• Denosumab is a key treatment for osteoporosis.
• Long-term treatment strategies after 20 doses require further elucidation.
• Understanding treatment trajectories is crucial for optimizing osteoporosis management.

Purpose of the Study:

• To describe treatment approaches following 20 denosumab doses.
• To examine bone mineral density (BMD) trajectories after treatment changes.
• To compare outcomes of continuing denosumab versus switching to zoledronic acid or romosozumab.

Main Methods:

• Retrospective single-center cohort study.
• Included patients receiving ≥20 consecutive denosumab doses.
• Analyzed BMD changes based on treatment continuation or transition.

Main Results:

• Most patients (48/54) continued denosumab, guided by BMD T-scores.
• Continuing denosumab increased lumbar spine and femoral neck BMD.
• Transitioning to zoledronic acid resulted in partial BMD loss; romosozumab increased lumbar spine BMD only.

Conclusions:

• Continuing denosumab beyond 20 doses is effective for lumbar spine and femoral neck BMD.
• Treatment decisions post-20 denosumab doses should consider BMD T-scores.
• No adverse events like atypical femoral fracture or osteonecrosis of the jaw were reported.