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Current Osteoporosis Reports

, Volume 17, Issue 1, pp 8–15 | Cite as

Stopping Denosumab

  • Olivier LamyEmail author
  • Delphine Stoll
  • Bérengère Aubry-Rozier
  • Elena Gonzalez Rodriguez
Therapeutics and Medical Management (S Jan de Beur and B Clarke, Section Editors)
Part of the following topical collections:
  1. Topical Collection on Therapeutics and Medical Management

Abstract

Purpose of Review

Denosumab discontinuation is associated with a rebound effect manifesting by an increased risk of multiple spontaneous vertebral fractures. The purpose of this review is to (1) better characterize this risk and (2) find solutions to avoid it.

Recent Findings

In the absence of a potent bisphosphonate prescription at denosumab discontinuation, the frequency of multiple vertebral fractures is common or frequent (≥ 1/100 and < 1/10). In five recent case series, the median number of vertebral fractures was 5 within 7 to 20 months (median 11) after the last denosumab injection. Prescribing bisphosphonate before starting denosumab and/or after stopping denosumab may reduce this risk. However, only small case series have evaluated these strategies.

Summary

After the second denosumab dose, there is a rebound effect with an increased risk of multiple vertebral fractures. A potent bisphosphonate prescribed at denosumab discontinuation could reduce this risk. As denosumab discontinuation is characterized by many uncertainties, denosumab is a second-line treatment for osteoporosis. Studies are urgently needed to define the management of denosumab discontinuation.

Keywords

Denosumab discontinuation Osteoporosis Rebound effect Spontaneous multiple vertebral fractures 

Notes

Compliance with Ethical Standards

Conflict of Interest

Olivier Lamy, Delphine Stoll, Bérengère Aubry-Rozier, and Elena Gonzalez Rodriguez declare that they have no conflict of interest.

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.

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Olivier Lamy
    • 1
    • 2
    Email author
  • Delphine Stoll
    • 1
  • Bérengère Aubry-Rozier
    • 1
    • 3
  • Elena Gonzalez Rodriguez
    • 1
    • 4
  1. 1.Center of Bone DiseasesLausanne University HospitalLausanneSwitzerland
  2. 2.Service of Internal MedicineCHUV, Lausanne University HospitalLausanneSwitzerland
  3. 3.Service of RheumatologyLausanne University HospitalLausanneSwitzerland
  4. 4.Service of Endocrinology, Diabetes and MetabolismLausanne University HospitalLausanneSwitzerland

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