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Steven R Cummings, Serge Ferrari, Jacques P Brown, Andrea T Wang, Response to Dr Lamy and Dr Gonzalez‐Rodriguez, Journal of Bone and Mineral Research, Volume 33, Issue 3, 1 March 2018, Page 548, https://doi.org/10.1002/jbmr.3403
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To the Editor:
Dr Lamy and Dr Gonzalez‐Rodriguez note that our analysis of risk of vertebral fractures after stopping denosumab, based on 0.2 to 0.5 years of median follow‐up, may underestimate the risk of vertebral fractures during longer periods of follow‐up. Indeed, our Discussion noted: “Because of the very short follow‐up period, only a minority of participants who discontinued from Extension had a scheduled radiograph and, therefore, the analysis may have substantially underestimated the risk of vertebral fracture after discontinuing denosumab.”(1) However, it is speculative and likely wrong to simply extrapolate a short‐term rate to a long‐term, 16‐month risk. Assuming increased bone resorption plays a role in the increased rate of vertebral fracture, Miller and colleagues showed that resorption increases sharply after denosumab discontinuation and then returns toward normal over 18 months;(2) likewise, the rate of vertebral fracture would also be higher early on after discontinuation and then decrease over time, as bone remodeling returns to baseline. A recent study found that, among 38 patients who were followed 17 months after the scheduled but omitted dose, 4 (10.5%) developed a vertebral fracture.(3)
