Denosumab Discontinuation Rebound Fractures — SCE Palliative Medicine MCQ

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HardPain ManagementDenosumab Discontinuation Rebound FracturesSCE Palliative Medicine

A 65-year‑old woman with advanced breast cancer on denosumab develops sudden severe lumbar pain. X‑ray shows multiple vertebral compression fractures. She has been on denosumab for 2 years and it was recently stopped due to progressive disease. What phenomenon has occurred?

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Correct answer: B — Rebound vertebral fractures following denosumab discontinuation

This scenario exemplifies the rebound-associated vertebral fractures that occur after stopping denosumab. Denosumab suppresses osteoclast-mediated bone resorption; upon cessation, there is a rapid rebound increase in bone turnover, leading to accelerated bone loss and risk of multiple vertebral compression fractures—typically within months of the last dose. The UK MHRA Drug Safety Update explicitly warns of multiple vertebral fractures within 18 months of treatment cessation ([gov.uk](https://www.gov.uk/drug-safety-update/denosumab-60mg-prolia-increased-risk-of-multiple-vertebral-fractures-after-stopping-or-delaying-ongoing-treatment?utm_source=openai)). The ECTS position statement supports the mechanism of rebound bone resorption causing multiple fractures after stopping denosumab ([pubmed.ncbi.nlm.nih.gov](https://pubmed.ncbi.nlm.nih.gov/28789921/?utm_source=openai)). Other options such as bed‑rest osteoporosis, vitamin D deficiency, spinal cord compression, or pathological fractures from cancer progression do not fit the temporal relationship, mechanism, or multiplicity of fractures following denosumab discontinuation.

Reference: https://www.nice.org.uk/guidance/conditions-and-diseases/cancer/palliative-care