When and how to stop denosumab therapy in a patient with osteoporosis

Abstract

Denosumab is a human monoclonal antibody that competitively inhibits the receptor activator of nuclear factor kappa B ligand which regulates osteoclast activity. It is an effective treatment for osteoporosis with a reduced cumulative rate of vertebral fractures, hip and nonvertebral fractures as well as an increase in bone mineral density. The benefits

Are secondary effects of bisphosphonates on the vascular system of bone contributing to increased risk for atypical femoral fractures in osteoporosis?

“…Support for this conclusion also comes from the literature regarding use of denosumab, a monoclonal antibody which blocks RANKL and inhibits osteoclasts, in the treatment of OP. [94,95] Denosumab use can also lead to bilateral AFF, [96][97][98] but it does not have anti-angiogenic effects in vitro or in vivo. [99] However, it should be noted that in the latter report, human umbilical vein EC were used for the in vitro studies, and these may not mimic EC from the microvasculature of post-menopausal females with OP.…”