RESULTS: The patient had been treated over 9 years with
pamidronate (cumulative dose of 810 mg) with incomplete control of
pain. Following initiation of
denosumab 60 mg subcutaneously, bone
pain and bone turnover markers (
osteocalcin, total and bone
alkaline phosphatase and carboxy-terminal cross-linking telopeptide of
type I collagen) were monitored over a 27 months period. Few hours after the first administration, the patient demonstrated a complete
pain disappearance and after 4 weeks bone turnover markers fell within the normal range. Three months after
denosumab initiation the patient reported a
pain reactivation that required a second administration, which again led to the
pain disappearance. Subsequently,
denosumab was administered according to the
pain reappearance and the injection was always followed by complete
pain relief. However, a gradual shortening of the
pain-free interval between administrations was observed, ranging from 90 to 75 days. All bone turnover markers stayed in the lower half of the normal range, even at the moment of
pain reappearance, suggesting that the effect of
denosumab on
pain depends on mechanisms other than
bone resorption suppression. No side effects were reported by the patient during the follow-up.
CONCLUSION: