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Denosumab discontinuation risk — SCE Rheumatology MCQ

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HardMetabolic Bone DiseaseDenosumab discontinuation riskSCE Rheumatology

A patient who stopped denosumab without follow-on treatment develops several vertebral fractures nine months later. What mechanism best explains this complication?

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Correct answer: A — Rebound increase in bone turnover after RANKL inhibition ends

Denosumab effects reverse rapidly when dosing is delayed or stopped, causing a rebound in bone turnover and risk of multiple vertebral fractures. Treatment therefore requires a planned antiresorptive transition rather than an unprotected drug holiday.

Reference: https://www.nice.org.uk/guidance/conditions-and-diseases/musculoskeletal-conditions