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Major depressive disorder — ABIM Board MCQ

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HardPsychiatry relevant to Internal MedicineMajor depressive disorderABIM Board

A 69-year-old woman at high fracture risk has received denosumab every six months for four years. She wants to stop because of cost; her next injection is due now. Kidney function is normal and she has no contraindication to bisphosphonates. What is the safest plan?

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Correct answer: C — Arrange timely bisphosphonate therapy rather than stop denosumab without transition

The best answer is “Arrange timely bisphosphonate therapy rather than stop denosumab without transition”. Denosumab cessation causes rebound bone turnover, rapid bone loss, and sometimes multiple vertebral fractures. It should not be delayed or stopped without subsequent antiresorptive therapy. A bisphosphonate timed to the denosumab interval is commonly used, with later bone-turnover and density assessment guiding further treatment.

Reference: Endocrine Society Guideline: Pharmacological Management of Osteoporosis: https://www.endocrine.org/clinical-practice-guidelines/osteoporosis-in-postmenopausal-women