Clin Osteol 2018; 23(1): 32-37

Long-term denosumab therapy for osteoporosis and its interruption: expert opinion of the Society for Metabolic Bone Diseases working group within the Czech Medical Association of J.E. PurkyněGuidelines

Bayer Milan; Horák Pavel; Palička Vladimír; Pavelka Karel; Pikner Richard; Rosa Jan; Šenk František; Vyskočil Václav; Zikán Vít

One characteristic of bisphosphonates, the most widely used group of antiresorptive drugs for osteoporosis, is their long retention in the skeletal system and persistence of the effect following treatment discontinuation. Compared to bisphosphonates, intervention of denosumab into the bone metabolism is deeper, however it is not deposited in the bone tissue and after its use is discontinued, increase in bone remodelling exceeds the initial level (rebound effect) within 12-18 months from the last dose, which is associated with accelerated decrease in bone mineral density (BMD). A series of case reports and analysis of patients who discontinued the use of denosumab within the study FREEDOM and its extension, have shown that this phenomenon may in some cases lead to an increased risk of multiple vertebral fractures (Rebound-Associated Vertebral Fractures, RAVF), in particular in patients with prevalent vertebral body fractures. Denosumab therapy should be long-term. The outcomes of analyses of smaller-scale clinical studies show that, in case it has been stopped, it must be followed by another antiresorptive treatment (typically with bisphosphonates). The opinion of the SMOS Working Group discusses the currently available data on the efficiency of different options of using bisphosphonates after stopping denosumab therapy, and proposes a care pattern for patients who ended this antiresorptive treatment for osteoporosis.


Key words:
denosumab -⁠ bisphosphonates -⁠ bone remodelling markers -⁠ brebound response -⁠ bone mineral density -⁠ vertebral fractures
Received 5. 9. 2018

Received: September 5, 2018; Published: June 11, 2018  Show citation