Introduction
Denosumab (DMAB), a monoclonal antibody against the receptor activator of nuclear factor k-B ligand (RANKL), is a potent antiresorptive agent commonly prescribed in patients with postmenopausal osteoporosis. DMAB reduces bone resorption and improves bone mineral density (BMD) (1).The FREEDOM trial found reduced risk of fragility fracture, a study that lasted 10 years (2,3)
Unlike bisphosphonates, which have a residual effect on bone when deposited therein (4), discontinuing DMAB treatment may produce a rebound effect on markers of bone remodeling and a loss of bone mass to the extreme that their values are even below the existing values before starting treatment (5). Furthermore, since 2015, several case reports and series were published describing multiple vertebral fractures (MVF) in patients discontinuing DMAB, which are also characterized by being painful. (6–9). Recently, 3 cases have been described of patients who suffered a hip fracture after the suspension of denosumab (10) and also repeated fractures in the same patient (11). The mechanism by which this complication occurs is unknown, as is its exact incidence (11).
Most of the articles published to date describe isolated cases or series with few patients. In this study, we present a series of 56 patients who suffered multiple vertebral fractures after discontinuing DMAB as well as a study of their clinical, analytical and densitometric characteristics. This series includes the largest number of patients published so far, with the aim of identifying prognostic factors for higher risk patients and establish the most appropriate preventive actions.