Denosumab Treatment for Osteoporosis

Introduction to Denosumab

Denosumab is recommended as a second-line pharmacologic treatment for osteoporosis in patients who have contraindications to or experience adverse effects of bisphosphonates, which remain the first-line therapy, according to the American College of Physicians 1, 2

Bisphosphonates remain first-line treatment for osteoporosis due to their favorable balance of benefits, harms, patient preferences, and lower cost, as stated by the American College of Physicians 1, 2
Denosumab is recommended as second-line therapy for patients who have contraindications to bisphosphonates, as recommended by the American College of Physicians 1
Denosumab is recommended as second-line therapy for patients who experience adverse effects from bisphosphonates, according to the American College of Physicians 1

Rebound bone loss after denosumab discontinuation is associated with multiple vertebral fractures in some patients, and bisphosphonate therapy should be considered to prevent rebound bone resorption, as noted by the American College of Physicians and the European Society for Medical Oncology 3, 4
After stopping denosumab, bisphosphonate therapy should be considered to prevent rebound bone resorption, as recommended by the European Society for Medical Oncology 4

No evidence supports routine bone mineral density monitoring during treatment, according to the American College of Physicians 5
For patients discontinuing denosumab, transition to a bisphosphonate is recommended to prevent rebound bone loss, as recommended by the European Society for Medical Oncology 4