Sign up now for ease of access to The Medical Independent, Ireland’s most frequently published medical newspaper, delivering award-winning news and investigative reporting.

  • receive the eCopy two days prior to the printed edition.
  • can partake in our online MCQs.
  • can enter our online sports quiz. is Ireland's only investigative medical news website for doctors, healthcare professionals and anyone with an interest in health issues.

Established in 2010, along with its sister publication The Medical Independent, our stated aim is to investigate and analyse the major issues affecting healthcare and the medical profession in Ireland. The Medical Independent has won a number of awards for its investigative journalism, and its stories are frequently picked up by national digital, broadcast and print media. The Medical Independent is published by GreenCross Publishing.

Address: Top Floor, 111 Rathmines Road Lr, Dublin 6

Tel: 353 (01) 441 0024

GreenCross Publishing is owned by Graham Cooke.

You are reading 1 of 2 free-access articles allowed for 30 days

Denosumab compliance is suboptimal

By Mindo - 15th Nov 2021 | 86 views

Osteoporosis patients on denosumab, the twice-yearly injectable monoclonal antibody, must be adequately educated on the risks of treatment non-compliance, such as rapid rebound bone loss and increased fracture risk, the Irish Osteoporosis Society (IOS) 2021 Annual Medical Conference heard. Dr Kevin McCarroll, Consultant Physician and Geriatrician specialising in bone health and osteoporosis at St James’s Hospital, Dublin, strongly advised against ‘drug holidays’ of denosumab, which had been a particular issue during Covid-19 despite guidelines being in place to continue and facilitate scheduled denosumab injections as a priority.

Research has shown that follow-on denosumab administered after nine-to-12 months versus the advised six months results in a 50 per cent decrease in bone mineral density (BMD) gains, with rapid BMD loss even after one month, and early risk of vertebral (x five) and, later, other fractures, Dr McCarroll told the conference. “The single biggest predictor [for a fracture after denosumab delay/stoppage] is probably previous vertebral fracture, the next biggest being duration of therapy….” Giving an overview of the benefits of denosumab in eligible osteoporosis patients, Dr McCarroll said that it is the most powerful antiresorptive bone mass agent currently available, and has better persistence than oral bisphosphonates, with its use continuing to rise in Ireland.

Patient studies have shown more satisfaction and preference for denosumab than weekly or monthly bisphosphonates. In addition, it has been proven to be cost-effective, with a potential cost saving in over 75s, those with previous fracture, and higher-risk patients, he said. Patients at high risk of fracture should probably continue denosumab therapy indefinitely, Dr McCarroll stated, emphasising the need to replace denosumab with a bisphosphonate “to close it off” and to continue checking bone markers if it is stopped. However, BMD loss can continue despite taking zoledronic acid after denosumab; and the risk of vertebral fracture may still be 5-to-10 per cent (in high-risk patients) after stopping despite bisphosphonate use. “So it won’t eliminate fracture risk”, Dr McCarroll stated. Quoting the results of a newly published Irish study on denosumab compliance, which looked at older patients newly prescribed oral bisphosphonates or denosumab during 2012-2017 from 44 general practices in Ireland, Dr McCarroll noted that denosumab continuation (persistence) at two years was 53.8 per cent in the 1,615 reviewed patients.

Only 5.7 per cent switched to alternative therapy (83 per cent of them transitioned to an oral bisphosphonate). Predictors of lower discontinuation of denosumab included having an osteoporosis diagnosis and being a medical card holder. Dr McCarroll said patients and clinicians need to be made aware of the risks of denosumab treatment stoppage, to help improve compliance. Strategies to improve compliance include multi-component education, pharmacist support, shared decision-making, and he noted that treatment satisfaction is important for persistence.

He also suggested that recall systems to remind GPs and patients of when the next dose of denosumab is due are useful, as has been shown by research in Australia and other countries. “So, in conclusion, denosumab persistence is suboptimal, 70 per cent at two years. Doses should not be missed by more than one month. What is key and crucial is education of patients and doctors about not stopping the injection….”

Leave a Reply

Latest Issue
The Medical Independent 9th May 2022

You need to be logged in to access this content. Please login or sign up using the links below.

Most Read