Calcified Tissue International

, Volume 101, Issue 4, pp 371–374 | Cite as

Bone Loss After Denosumab: Only Partial Protection with Zoledronate

  • Ian R. Reid
  • Anne M. Horne
  • Borislav Mihov
  • Gregory D. Gamble
Original Research


A case series of six women with postmenopausal osteoporosis who had received continuous denosumab for 7 years and were then given a single infusion of zoledronate (5 mg) is reported. During denosumab treatment, bone mineral density (BMD) in the spine increased 18.5% (P = 0.006), and total hip BMD by 6.9% (P = 0.03). Post-zoledronate BMDs were measured 18–23 months after treatment, and there were significant declines at each site (P spine = 0.043, P hip = 0.005). Spine BMD remained significantly above the pre-denosumab baseline (+9.3%, P = 0.003), but hip BMD was not significantly different from baseline (−2.9%). At the time of post-zoledronate BMD measurements, serum PINP levels were between 39 and 60 μg/L (mean 52 μg/L), suggesting that the zoledronate treatment had not adequately inhibited bone turnover. It is concluded that this regimen of zoledronate administration is not adequate to preserve the BMD gains that result from long-term denosumab treatment.


Osteoporosis Denosumab Bisphosphonates Zoledronate 



This study was supported by the Health Research Council of New Zealand.

Compliance with Ethical Standards

Conflict of interest

Ian R. Reid has received research grants and honoraria from Amgen, Novartis, Merck, and Lilly. Anne M. Horne, Borislav Mihov, and Gregory D.Gambie have nothing to declare.

Human and Animal Rights and Informed Consent

The FREEDOM study and its extensions were approved by our regional ethics committee.


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Copyright information

© Springer Science+Business Media New York 2017

Authors and Affiliations

  1. 1.Department of Medicine, Faculty of Medical and Health SciencesUniversity of AucklandAucklandNew Zealand
  2. 2.Department of EndocrinologyAuckland District Health BoardAucklandNew Zealand
  3. 3.Faculty of Medical and Health SciencesUniversity of AucklandAucklandNew Zealand

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