Denosumab – evolving management of a therapy in bone health

Dr Kevin McCarroll, Consultant Physician and Geriatrician, Bone Health Unit, St James Hospital, Dublin, gave a detailed presentation on the use of denosumab in osteoporosis at the 2023 Irish Osteoporosis Society Annual Medical Conference.

Denosumab is a human monoclonal antibody for the treatment of bone loss in severe osteoporosis, which is administered via injection every six months, and has been shown to be very effective and safe for long-term use (10 years plus).

There is evidence that denosumab discontinuation causes rebound high bone turnover and rapid bone loss within one year, and increases the risk of multiple vertebral fractures, particularly among those with existing vertebral fractures.

The risk of a vertebral fracture on stopping denosumab (after three years of therapy) is over 10 per cent and multiple vertebral fractures over 7.5 per cent, with fractures frequently occurring from six months after cessation, Dr McCarroll explained.

While there is increasing awareness of the risk of rebound loss and vertebral fractures on stopping denosumab, not all GPs or patients are aware of this, he noted. Thus, it is vital that osteoporosis patients and primary care practitioners are made aware that “denosumab should not be stopped or delayed without discussion with a healthcare professional”.

Also speaking during this session was Mr Nicholas Flood, who discussed reciprocal relationships in health adaptation in relation to connective tissue disorders.

Mr Flood works as a practising osteopath in Dublin and has seen both sides of the medical profession as both a practitioner and patient. He was diagnosed as having osteogenesis imperfecta type 1 at two years of age, and to date the condition has led to him having over 60-to-70 fractures. He gave an inspiring overview of his life and achievements in sport (being a professional marksman and representing Ireland and winning major competitions), overcoming many challenges despite his condition.

Mr Flood was also diagnosed with osteoporosis as an adult, but with the correct nutrition and treatment under Prof O’Brien and others, his health greatly improved and he salvaged his sporting career. He discussed the key role of correct nutrition, supplementation and exercise in managing osteogenesis imperfecta.

Mr Flood also discussed the role of osteopathy in treating a wide range of conditions such as general aches and pains, joint pain/injuries, headaches/migraines, and circulatory issues. “Since the treatment is so gentle, it can be used by people of all ages to treat different problems. Osteopathy is used to aid healing for a wide range of conditions and health concerns, creating an optimal healing environment for the body.”