Denosumab Mechanism — SCE Rheumatology MCQ
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Correct answer: D — Neutralisation of RANKL, inhibiting osteoclast formation, function and survival
Denosumab is a human IgG2 monoclonal antibody that binds RANK ligand (RANKL), preventing it from activating RANK on osteoclast precursors and mature osteoclasts. This inhibits osteoclast formation, function and survival, reducing cortical and trabecular bone resorption. Neutralisation of sclerostin describes romosozumab, an anabolic and antiresorptive antibody. Selective oestrogen receptor modulation describes raloxifene. Binding to hydroxyapatite with subsequent uptake by active osteoclasts is characteristic of bisphosphonates. Activation of the parathyroid hormone 1 receptor describes PTH analogues such as teriparatide, which stimulate bone formation when administered intermittently.
Reference: Electronic Medicines Compendium. Prolia 60 mg solution for injection in pre-filled syringe, Summary of Product Characteristics, section 5.1 Pharmacodynamic properties: Mechanism of action. Text revised 17 July 2026. https://www.medicines.org.uk/emc/product/568/smpc