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Denosumab Mechanism — MFDS Part 1 MCQ

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HardHuman DiseaseDenosumab MechanismMFDS Part 1

A patient receiving denosumab is identified as being at risk of medication-related osteonecrosis of the jaw. Which molecular action most accurately distinguishes denosumab from a nitrogen-containing bisphosphonate?

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Correct answer: D — Neutralisation of RANKL, preventing RANK activation on osteoclast-lineage cells

Explanation lettering: C = shown as A · E = shown as C · A = shown as D · D = shown as E

A is correct. Denosumab is a human monoclonal antibody that binds RANKL, preventing RANK activation on osteoclast precursors and mature osteoclasts. This inhibits osteoclast formation, function and survival. Unlike bisphosphonates, denosumab does not bind bone hydroxyapatite. Option C describes nitrogen-containing bisphosphonates, which are taken up by osteoclasts and inhibit farnesyl pyrophosphate synthase. Denosumab binds existing RANKL rather than suppressing its transcription, so B is incorrect. Calcitonin-receptor agonism in D is the mechanism of calcitonin, while cathepsin K inhibition in E represents a different anti-resorptive drug strategy.

Reference: Amgen Ltd. Prolia 60 mg solution for injection in pre-filled syringe, Summary of Product Characteristics, section 5.1 Mechanism of action. Revised 17 July 2026. https://www.medicines.org.uk/emc/product/568/smpc