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Denosumab Discontinuation — RACP Adult Medicine MCQ

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ModerateClinical PharmacologyDenosumab DiscontinuationRACP Adult Medicine

A 72-year-old woman with osteoporosis on denosumab for 5 years wishes to cease treatment. What is the critical risk associated with denosumab discontinuation?

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Correct answer: E — Avascular necrosis of the jaw

Unlike bisphosphonates (which have a prolonged skeletal half-life), denosumab cessation causes rapid rebound bone resorption with accelerated bone loss and increased risk of multiple vertebral fractures within 6–12 months. Sequential therapy with a bisphosphonate (e.g. zoledronic acid infusion) must be commenced within 6 months of the last denosumab dose to prevent this rebound effect. This is one of the most important prescribing considerations for denosumab.

Reference: RACGP – 2017 – Osteoporosis Guideline; eTG – 2025 – Rheumatology