Discontinuing denosumab treatment for osteoporosis, even with a transition to zoledronate, leads to significant bone mineral density (BMD) loss in the lumbar spine within a year, according to a new study. This highlights the challenge of preventing the rapid rebound bone loss that occurs after stopping denosumab, even when switching to bisphosphonates.
The study included 101 patients, both postmenopausal women and men over 50, who had been on denosumab for at least 2 years without prior use of other osteoporosis treatments. Participants were randomized to either continue denosumab (60 mg twice yearly) or discontinue it and receive a single intravenous dose of zoledronate (5 mg) timed with their next denosumab dose.
After one year, patients transitioning to zoledronate experienced a notable decline in lumbar spine BMD, while those continuing denosumab saw a modest increase. No significant differences were observed in total hip BMD or femoral neck BMD between the two groups.
Further analysis revealed that patients with longer denosumab use (≥3 years) experienced even greater lumbar spine BMD loss when switched to zoledronate compared to those who remained on denosumab. These findings underscore the difficulty in mitigating bone loss after stopping denosumab, particularly in long-term users.
