Rebound-associated vertebral fractures after discontinuation of denosumab for the treatment of maxillitis

• Published in: Osteoporosis international Vol. 29; no. 3; pp. 769 - 772
• Main Authors: Niimi, R., Kono, T., Nishihara, A., Hasegawa, M., Sudo, A.
• Format: Journal Article
• Language: English
• Published: London Springer London 01-03-2018; Springer Nature B.V
• Subjects: Aged; Bone Density Conservation Agents - administration & dosage; Bone mineral density; Bone turnover; Case Report; Denosumab - administration & dosage; Drug Administration Schedule; Endocrinology; Female; Fractures; Humans; Immunotherapy; Injection; Low back pain; Magnetic resonance imaging; Maxilla; Medicine; Medicine & Public Health; Monoclonal antibodies; Orthopedics; Osteitis - surgery; Osteoporosis; Osteoporosis, Postmenopausal - drug therapy; Osteoporotic Fractures - etiology; Pain; Preoperative Care - adverse effects; Preoperative Care - methods; Rheumatology; Spinal Fractures - etiology; Tooth Extraction; Trauma; Vertebrae; Withholding Treatment; Denosumab; Discontinuation of treatment; Rebound-associated vertebral fractures
• ISSN: 0937-941X; 1433-2965
• DOI: 10.1007/s00198-017-4334-3

We reported a 69-year-old female who discontinued denosumab due to dental treatment and subsequently suffered rebound-associated vertebral fractures 10 months after the last injection. This case raised an alarm regarding the discontinuation of denosumab for dental treatment. Denosumab, a human monoclonal antibody administered by subcutaneous injection, to the best of our knowledge, is the only fully investigated inhibitor of receptor activator of nuclear factor kappa B ligand. Discontinuation of denosumab leads to bone turnover rebound and rapid bone mineral density loss. Several studies have reported rebound-associated vertebral fractures after discontinuation of denosumab. We report on a new case of rebound-associated vertebral fractures after discontinuation of denosumab. A 69-year-old female, who withdrew from denosumab treatment after 3 years due to maxillitis, presented to our hospital with severe low back pain without any history of trauma. Ten months had passed since the last injection. Magnetic resonance imaging showed five acute vertebral fractures, which appeared to be rebound-associated vertebral fractures caused by discontinuation of denosumab due to dental treatment. This case clearly demonstrates the risk of discontinuation of denosumab for dental treatment.