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Denosumab Discontinuation

  • Therapeutics and Medical Management (S Jan De Beur and B Clarke, Section Editors)
  • Published:
Current Osteoporosis Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

To review the pathophysiology, the clinical consequences as well as way of mitigating the effects of denosumab discontinuation.

Recent Findings

Treatment with denosumab (DMAB) is reversible and upon discontinuation there is a rapid increase in bone turnover and a subsequent bone loss. During this phase of high bone turnover, an increased risk of fractures has been reported. Therefore, treatment with DMAB could be considered life-long. However, side-effects may prompt the need for discontinuation and moreover, treatment with DMAB may have increased BMD to levels where continuing treatment does not provide further fracture risk reduction. Patients stopping DMAB should be offered subsequent antiresorptive treatment with an intense monitoring regimen during the initial year as most of the bone loss occurs within these initial 12 months.

Summary

In this review, we evaluated the literature published over the past 1 to 3 years investigating DMAB withdrawal with focus on bone turnover markers, bone mineral density, and fracture risk and the transition to other anti-osteoporosis therapies. Furthermore, we summarized the current recommendations of international guidelines.

Mini Abstract

In this review, we evaluated the literature published over the past 1 to 3 years investigating denosumab (DMAB) discontinuation and the transition to other anti-osteoporosis therapies. Additionally, we summarized the current recommendations of international guidelines.

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Authors and Affiliations

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

    Anne Sophie Sølling, Torben Harsløf & Bente L Langdahl

  2. Department of Internal Medicine, Silkeborg Regional Hospital, Silkeborg, Denmark

    Anne Sophie Sølling

  3. Department of Medicine III & Center for Healthy Aging, Universitätsklinikum Dresden, Dresden, Germany

    Elena Tsourdi

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  1. Anne Sophie Sølling
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  2. Elena Tsourdi
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  4. Bente L Langdahl
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The corresponding author attests that all listed authors meet the authorship criteria and that no others meeting the criteria have been omitted.

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Correspondence to Bente L Langdahl.

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Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Conflict of interest

Torben Harsløf received lecture fees from Amgen, Astra Zeneca, UCB, and Eli Lilly.

Bente Langdahl received research funding to her institution from Amgen and Novo Nordisk. Bente Langdahl serves on advisory boards and speaker’s bureau for Amgen, UCB, Gilead, Astra-Zenica, Astellas, and Gedeon-Richter.

Elena Tsourdi received research funding from MSD, honoraria for lectures from Amgen, UCB, Shire, Kyowa Kirin, and educational grants from Shire and UCB.

Anne Sophie Sølling received lecture fees from Amgen and Gedeon-Richter.

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Sølling, A.S., Tsourdi, E., Harsløf, T. et al. Denosumab Discontinuation. Curr Osteoporos Rep 21, 95–103 (2023). https://doi.org/10.1007/s11914-022-00771-6

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