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Denosumab Timing — RACP Adult Medicine MCQ

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ModerateGeriatric MedicineDenosumab TimingRACP Adult Medicine

A 78-year-old woman with known osteoporosis on denosumab for 3 years develops back pain. X-ray shows a new T12 vertebral compression fracture. She is currently due for her next denosumab injection. What is the most important action?

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Correct answer: D — Administer denosumab on time

Denosumab must be administered strictly every 6 months without delay. Missing or delaying doses leads to rapid rebound bone loss with significantly increased vertebral fracture risk within months of the missed dose. The new vertebral fracture occurred while ON denosumab, suggesting severe osteoporosis requiring therapy intensification (consider adding teriparatide sequentially) but the immediate priority is to NOT miss the scheduled dose. Investigation for secondary causes (myeloma, metastases) is also appropriate.

Reference: eTG – 2025 – Rheumatology; ASBMR – 2022 – Denosumab Position Statement