Published in:
01-05-2016 | Editorial
Cancel the denosumab holiday
Author:
M. R. McClung
Published in:
Osteoporosis International
|
Issue 5/2016
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Excerpt
Denosumab, a fully human IgG2 anti-RANK ligand antibody, quickly and substantially inhibits bone remodeling [
1]. As expected by the pharmacology of denosumab, this inhibition of remodeling is completely reversible upon stopping treatment [
2]. In clinical trials, discontinuing therapy after 2 years results in a rapid rebound in bone turnover markers, raising concern about whether that high remodeling rate and consequent rapid bone loss that occurs has clinical relevance beyond a simple waning of the treatment benefit [
3,
4]. Despite these concerns, many patients stop denosumab therapy, sometimes upon the advice of their physicians, especially in preparation for invasive dental procedures [
5‐
7]. Three recent reports have described five patients in whom denosumab treatment was stopped because substantial gains on bone mineral density (BMD) had been achieved and who then experienced vertebral fractures within the first several months after discontinuing therapy. These cases re-focus our attention on the concern about a rebound in fracture risk and make it clear that a “holiday” from denosumab therapy is not justified in patients with osteoporosis [
8‐
10]. …