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The FREEDOM trial demonstrated that treatment with denosumab reduced fracture risk at several skeletal sites over a 3-year period. Other studies have shown that discontinuing denosumab therapy can result in a transient increase in bone remodeling and a decline in bone mineral density (BMD). Brown et al. investigated whether patients from the FREEDOM trial in the denosumab treatment group were at a greater risk of fractures after therapy was stopped, compared to patients in the placebo group.1 As expected, the placebo group had shown a higher rate of fractures during the treatment period and had also shown a more marked decrease in BMD. During an off-treatment period of 7–24 months, 42% of patients in the placebo group started other therapies for osteoporosis compared to 28% of the denosumab group. However, fracture rates in the two groups were similar and no real differences could be detected. Editor’s comment: This observational study provides some reassurance about the consequences of denosumab discontinuation and the subsequent rebound effect on bone turnover. The observed fracture rate was the same in both groups even though fewer of the patients previously given denosumab treatment started other osteoporosis treatments during the study period. Download references

Discontinuing denosumab treatment does not increase fracture risk