Can Zoledronate Protect Against Bone Loss in People Who Discontinue Denosumab?

Denosumab improves bone-mineral density (BMD) and lowers fracture risk in people with osteoporosis. Indefinite therapy usually is recommended, because discontinuation is associated with rebound bone loss. But for patients who do stop using denosumab, does following up with a bisphosphonate lower risk for rebound bone loss?

In this randomized Taiwanese trial, 101 patients (median age, 72; 95% women) who had taken denosumab for ≥2 years were randomized to continue denosumab or to switch to intravenous zoledronate (single dose given 6 months after the last denosumab dose). After 1 year, total hip and femoral-neck BMD were similar in the two groups, but the zoledronate group's median decline in spinal BMD was significantly greater than the denos…