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.