Denosumab discontinuation in the clinic: implications of rebound bone turnover and emerging strategies to prevent bone loss and fractures.

72 Intriguingly, the subgroup of patients who had increased bone turnover at 6 mo (CTx > mean reference-range) showed a trend for greater BMD gains on treatment, and despite a second dose of zoledronic acid, lost 5% BMD at spine and alarmingly 10% of this group experienced VFs. 29 Conversely, achieving CTx below this threshold 6 mo after an initial zoledronic acid dose was a reliable indicator for subsequent BMD preservation.

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