# Romosozumab after rebound vertebral fractures induced by denosumab discontinuation: a case series

## TL;DR

This case series explores romosozumab as a treatment for vertebral fractures caused by stopping denosumab, showing improved bone health and no new fractures.

## Contribution

Reports romosozumab's potential as a treatment for post-denosumab rebound fractures, a novel use of a dual-action agent in this clinical context.

## Key findings

- All patients showed progressive improvement in bone mineral density and microarchitecture.
- Bone turnover markers were suppressed, and no new clinical fractures occurred during treatment and follow-up.

## Abstract

Introduction: Discontinuation of denosumab can lead to a rebound increase in bone resorption, which may result in multiple vertebral fractures. Current guidelines recommend retreatment with denosumab or administration of zoledronate in this setting. Materials and methods: We report a series of 4 patients who developed vertebral fractures following denosumab withdrawal and were subsequently treated with romosozumab, a dual-action agent with anabolic and antiresorptive properties. Results: All patients showed progressive improvement in BMD and microarchitecture, with suppression of bone turnover markers and no new clinical fractures during treatment and follow-up. Discussion: Although limited by the uncontrolled design and small sample size, these observations suggest that romosozumab might be considered as a potential therapeutic approach for selected patients with post-denosumab rebound fractures.

Graphical Abstract