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Missed Denosumab Dose — SCE Rheumatology MCQ

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ModerateMetabolic Bone DiseaseMissed Denosumab DoseSCE Rheumatology

A 50-year-old woman receiving denosumab 60 mg every 6 months for osteoporosis is reviewed 8 months after her last injection because her scheduled dose was missed. Treatment remains indicated, calcium and vitamin D status are satisfactory, there is no new contraindication, and denosumab is available today. What is the most appropriate management?

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Correct answer: D — Administer denosumab today and schedule the next injection 6 months from today

The correct answer is D. UK product information states that a missed denosumab dose should be administered as soon as possible, with subsequent injections scheduled every 6 months from the date of the delayed injection. Denosumab's antiresorptive effect is rapidly reversible, and prolonged dosing gaps are associated particularly with increased vertebral fracture risk. It should therefore not be deferred to an arbitrary future date or until 12 months after the previous dose. A bisphosphonate is important when denosumab is being intentionally discontinued or cannot be continued, but it is not the routine substitute for an isolated missed dose when denosumab remains indicated and is available immediately. Permanent cessation without sequential antiresorptive treatment would expose the patient to rebound bone loss and fracture risk.

Reference: Amgen Limited. Prolia 60 mg solution for injection in pre-filled syringe — Patient Information Leaflet, section 3 'If you forget to use Prolia'; leaflet revised February 2026, eMC updated 21 July 2026. https://www.medicines.org.uk/emc/product/568/pil