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Denosumab discontinuation — SCE Rheumatology MCQ

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HardMetabolic Bone DiseaseDenosumab discontinuationSCE Rheumatology

A 74-year-old woman has received denosumab for osteoporosis for 4 years. She wants to stop because injections are inconvenient. She has previous vertebral fractures and eGFR 48 mL/min/1.73 m². Calcium and vitamin D are satisfactory. What is the most appropriate management?

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Correct answer: D — Plan sequential antiresorptive therapy rather than abrupt cessation

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

Plan sequential antiresorptive therapy rather than abrupt cessation is best because denosumab cessation can cause rebound bone turnover and vertebral fractures, so sequential antiresorptive planning is required. B is less suitable because abrupt cessation risks rebound fractures; C is less suitable because improved BMD does not remove rebound risk; D is less suitable because colchicine has no osteoporosis role; E is less suitable because prednisolone worsens bone loss. Clinical pearl: denosumab is not simply stopped; an exit strategy is part of safe prescribing.

Reference: NOGG osteoporosis guideline; BNF