Prevention and Management of Denosumab Discontinuation Rebound Fractures

Denosumab rebound-associated fractures occur in approximately 1 out of 14 patients who discontinue denosumab therapy without sequential antiresorptive therapy. They occur due to excessive bone resorption after missed or delayed denosumab doses. The fractures are multiple and quality of life altering. This phenomenon occurs in all patient populations that use prolonged denosumab therapy. Average delay in denosumab dosing beyond 7 months or discontinuation of denosumab without sequential therapy is associated with increased mortality in retrospective studies. Multiple medication regimens used after the end of denosumab therapy have been shown to substantially reduce the risk of rebound vertebral fractures.