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Oral contraceptive and enzyme inducer — GPhC CRA MCQ

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HardEndocrine TherapeuticsOral contraceptive and enzyme inducerGPhC CRA

A patient receiving denosumab 60 mg every six months for osteoporosis wants to omit the next injection indefinitely because they feel well. They had a vertebral fracture before treatment. What is the best advice?

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Correct answer: D — Do not stop or delay without a specialist bone-protection plan

Unlike bisphosphonates, denosumab does not provide a residual skeletal “holiday” effect. The MHRA reports multiple vertebral fractures after stopping or delaying treatment, with previous vertebral fracture a particularly important risk factor. A specialist should reassess ongoing treatment and plan sequential antiresorptive therapy where appropriate; calcium alone and arbitrary interval extension do not prevent rebound bone turnover.

Reference: MHRA: denosumab and vertebral fractures after stopping. https://www.gov.uk/drug-safety-update/denosumab-60mg-prolia-increased-risk-of-multiple-vertebral-fractures-after-stopping-or-delaying-ongoing-treatment