Denosumab Discontinuation

TY - JOUR

T1 - Denosumab Discontinuation

AU - Sølling, Anne Sophie

AU - Tsourdi, Elena

AU - Harsløf, Torben

AU - Langdahl, Bente Lomholt

PY - 2023/2

Y1 - 2023/2

N2 - 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.

AB - 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.

KW - Bone mineral density

KW - Bone turnover markers

KW - Denosumab

KW - Fracture

KW - Osteoporosis

KW - Osteoporosis, Postmenopausal/drug therapy

KW - Bone Density

KW - Denosumab/therapeutic use

KW - Humans

KW - Fractures, Bone/chemically induced

KW - Female

KW - Bone Density Conservation Agents/adverse effects

UR - http://www.scopus.com/inward/record.url?scp=85144679328&partnerID=8YFLogxK

U2 - 10.1007/s11914-022-00771-6

DO - 10.1007/s11914-022-00771-6

M3 - Review

C2 - 36564572

SN - 1544-1873

VL - 21

SP - 95

EP - 103

JO - Current Osteoporosis Reports

JF - Current Osteoporosis Reports

IS - 1

ER -