Bone Health in Oncology: Defining Biosimilar Denosumab Use Through Multidisciplinary Collaboration

Bone metastases represent a major source of morbidity in advanced solid tumors, leading to skeletal-related events (SREs), pain, and impaired quality of life. Although guidelines recommend the use of bone-modifying agents (BMAs) to prevent SREs, real-world data consistently show delayed initiation, inconsistent dosing, and poor treatment persistence for these agents. This ongoing undertreatment contributes to preventable skeletal complications, greater healthcare utilization, and diminished patient outcomes. Denosumab and bisphosphonates remain the cornerstone of bone-targeted therapy. Recent evidence indicates that sustained BMA use is strongly associated with preserved functional status, reduced bone pain, and potentially improved survival. However, access and affordability continue to limit optimal use in many settings. The introduction of denosumab biosimilars offers an important opportunity to address these barriers. Phase III trials across multiple denosumab biosimilars developed by Sandoz, Samsung Bioepis, Celltrion, and Fresenius Kabi have shown equivalent efficacy, safety, and immunogenicity to the reference denosumab, with comparable lumbar spine bone mineral density gains and low rates of adverse events. Budget-impact modeling projects substantial cost savings and expanded patient access, reinforcing their role in reducing financial toxicity and promoting more equitable bone health care. Optimal management of bone metastases requires coordinated, multidisciplinary care involving oncologists, dentists, nurses, pharmacists, radiologists, rehabilitation specialists, supportive and palliative care teams. Such collaboration ensures timely BMA initiation, preventive dental evaluation, adherence monitoring, and continuity of therapy across systemic treatment lines. Integrating biosimilars within structured, patient-centered care pathways offers a sustainable strategy to close existing treatment gaps and improve outcomes for patients with bone metastases.