A Review on the Role of Denosumab in Fracture Prevention

Abstract

Denosumab is a receptor activator of nuclear factor kappa-Β ligand inhibitor, which suppresses the bone resorption process to preserve bone mass. It is usually recommended to postmenopausal women and men with high fracture risk. With the recent publication of the results from FREEDOM study and its extension, the long-term effect of denosumab in preventing fragility fractures has been put forward. This review aims at summarising the evidence of denosumab in reducing fracture risk and its safety derived from clinical studies. Most of the evidence are derived from FREEDOM trials up to 10 years of exposure. Denosumab is reported to prevent vertebral and non-vertebral fractures. It is also proven effective in Japanese women, patients with chronic kidney diseases and breast cancer patients receiving antineoplastic therapy. Denosumab discontinuation leads to high remodeling, loss of bone mineral density and increased fracture risk. These negative effects might be preventable by bisphosphonate treatment. The safety profile of denosumab is consistent with increased years of exposure. In conclusion, denosumab is a safe and effective option for reducing fracture risk among patients with osteoporosis.

Keywords:

• bone mineral density
• bone turnover marker
• menopause
• osteopenia
• osteoporosis

Acknowledgments

The authors thank Universiti Kebangsaan Malaysia for funding them via Fundamental Research Grant (FF-2020-145). Dr. Kok-Lun Pang is a postdoctoral researcher funded by Universiti Kebangsaan Malaysia through Postdoctoral Research Scheme (RGA1).

Disclosure

The authors report no conflicts of interest in this work.