Denosumab is a highly effective treatment for
postmenopausal osteoporosis, significantly improving BMD and reducing risk of fracture. However,
denosumab's effect is transient with the risk of a rebound increase in bone turnover following withdrawal of this potent RANKL inhibitor. This poses challenges, particularly in individuals seeking to discontinue
denosumab, such as those experiencing a direct complication of prolonged antiresorptive
therapy or those in whom an antiresorptive drug holiday would be ordinarily considered.
Bisphosphonate strategies to mitigate postdenosumab bone loss are being actively studied. We describe the case of a 73-year-old woman who developed a spontaneous vertebral fracture following
denosumab discontinuation, despite prolonged treatment with
bisphosphonate therapy both before her course of
denosumab (20 years of use) and following
denosumab discontinuation (1 year of use). This is a cautionary case seeking to highlight uncertainties around the safe withdrawal of
denosumab therapy despite intervening treatment with
bisphosphonates. © 2020 The Authors. JBMR Plus published by Wiley Periodicals, Inc. on behalf of American Society for Bone and
Mineral Research © 2020 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and
Mineral Research.