ArticleOsteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA2026
Follow-on osteoporosis therapy after denosumab discontinuation among Medicare beneficiaries.
Article in Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers, 1 of them a synthesis that pooled it.
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3 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Pooled it
- A hypoxia-responsive calixarene supramolecular system enables redox-regulated matrix remodeling for postmenopausal osteoporosis.Materials today. Bio · 2026Article
- Mechanisms and management strategies for exacerbated bone loss following denosumab discontinuation.Frontiers in aging · 2026Review
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Abstract
Denosumab is an effective osteoporosis therapy, but discontinuing treatment can result in rebound-associated fractures. Guidelines recommend starting follow-on osteoporosis therapy within 6 months of the last dose, but real-world practice is under-described. We found only 6.0% of patients initiated follow-on therapy within 1 year after denosumab discontinuation, suggesting many are at increased fracture risk. PURPOSE: We aimed to describe the incidence and predictors of follow-on osteoporosis therapy use for US Medicare beneficiaries who discontinued denosumab.
methodsIn this cohort study, we identified patients who initiated denosumab (60 mg) between 2010 and 2021 from a 20% random sample of Medicare beneficiaries. Denosumab discontinuation was defined as 60-day gap in use. During follow-up through 2022, we identified beneficiaries with follow-on osteoporosis therapy (i.e., oral and intravenous bisphosphonates, teriparatide, and abaloparatide) within 1 year after denosumab discontinuation. Multinomial logistic regression with marginal standardization was used to estimate risk ratios with 95% confidence limits for associations between covariates and follow-on therapy use after denosumab discontinuation.
resultsOf 120,952 denosumab initiators, we identified 82,519 individuals (mean age = 79.1 years [SD = 7.2]; 90.3% female) who discontinued denosumab. Only 4912 (6.0%) individuals initiated follow-on therapy after discontinuation; mean time from discontinuation (last claim + 243 days) to follow-on therapy initiation was 3.3 months [SD = 3.4]. Alendronate (n = 3014; 3.7%), zoledronic acid (n = 687; 0.8%), and ibandronate (n = 581; 0.7%) were most common. Most people did not initiate follow-on therapy (43.9%) or reinitiated denosumab after a gap (41.3%), with 8.8% lost to follow-up. Younger age (vs. ≥ 85 years), female sex, prior osteoporosis therapy, and Having 1-2 denosumab claims (vs. longer therapy) before discontinuation were strong predictors of follow-on therapy initiation versus no follow-on therapy.
conclusionMany patients stopping denosumab do not receive follow-on therapy. Proactive follow-up and strong clinical communication would reduce treatment gaps and prompt follow-on therapy after discontinuation.
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