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Osteoporosis Update Part 1: Denosumab
November 14 2016 7:47 PM ET — via RheumReports
Osteoporosis has been characterized as a skeletal disorder of reduced bone strength that leads to an increased risk for fracture. Dr. Nelson Watts addressed long-term therapy with denosumab, a human MAb for the treatment of osteoporosis, treatment-induced bone loss, bone metastases,and giant cell tumor of bone. Denosumab is a RANK ligand inhibitorthat works by preventing the development of osteoclasts, the cells that break down bone.
The most common adverse reactions with denosumab include back pain, pain in the extremities, musculoskeletal pain and cystitis. In a placebo-controlled trial, rates of these adverse events were similar to denosumab, and the rates of other reactions were about the same as those found in the general population. The use of denosumab with anti-TNF agents did not increase hospitalization rates or rates of infection. So although we need to re-evaluate our patients after taking medications for 5 years, we do not need to take them off denosumab at that time. In other words, no "drug holiday" is needed.
Based on data from 3 RCTs that evaluated patients transitioning from oral bisphosphonates to denosumab, greater long-term gains were achieved when denosumab was used in combination with these agents. Studies also suggest that sequencing is important. Denosumab following teriparatide showed increased gains but switching from denosumab to teriparatide did not. Therefore, follow teriparatide with denosumab or use them in combination, but do not switch from denosumab to teriparatide.
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About the Author
Marlene Thompson
Marlene Thompson is an Associate Clinical Professor in Physical Therapy at Western University and an Advanced Physiotherapy Practitioner in Arthritis Care. MarleneÔǦs research interests include models of care, triage, advanced practice roles, and arthritis education.
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