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Denosumab discontinuation — SCE Rheumatology MCQ

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HardMetabolic bone diseaseDenosumab discontinuationSCE Rheumatology

A 78-year-old woman received denosumab for osteoporosis for four years but missed two injections after moving care homes. She now presents with acute back pain and MRI shows multiple new vertebral compression fractures. Calcium is normal. What is the most likely explanation?

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Correct answer: C — Rebound bone turnover after denosumab discontinuation

Denosumab discontinuation or delayed dosing can cause rebound bone turnover and multiple vertebral fractures. Treatment plans should include timely dosing or transition to another antiresorptive, often a bisphosphonate if appropriate. Atypical femoral fracture involves subtrochanteric or femoral shaft pain and fracture patterns, not multiple vertebral fractures.

Reference: NOGG osteoporosis guideline; BNF