A single infusion of zoledronate prevents bone loss in patients discontinuing denosumab

Denosumab is one of the most potent agents available for the treatment of osteoporosis, administered in millions of patients worldwide. It is a monoclonal antibody that inhibits RANKL, a molecule essential for osteoclast proliferation, maturation, activity, and survival. By inhibiting the osteoclasts, the cells responsible for bone resorption, denosumab substantially decreases bone resorption and turnover, increases bone mineral density, and reduces the risk of fractures in patients with osteoporosis. In many patients, several years of denosumab treatment result in bone mineral density measurements within the non-osteoporotic range. Unfortunately, denosumab discontinuation results in rapid, profound loss of most of the gains in bone density that had been achieved with the treatment. This bone loss is accompanied by an increased risk for fractures, which in some patients may lead to multiple vertebral fractures, in a few months following treatment discontinuation. Several research groups have aimed to find a way to maintain the benefits of denosumab treatment after its discontinuation and avert these adverse phenomena.

So far, a few reports including a very small number of patients have been published on the subject. In the first randomized-controlled trial aiming to address this clinically important issue, published in the Journal of Bone and Mineral Research, the ECTS Academy member Athanasios Anastasilakis and colleagues found that a single intravenous infusion of zoledronate, another agent used in osteoporosis treatment, when given 6 months after the last denosumab injection prevents bone loss for at least 2 years in the majority of the patients. More importantly, the risk of vertebral fractures also seems to be averted.

See the original article here: https://asbmr.onlinelibrary.wiley.com/doi/abs/10.1002/jbmr.3853