After 5-10 years, the use of denosumab can be reevaluated based on risk of facture.

If a patient is improving and content to continue denosumab, therapy can be continued indefinitely acknowledging that there is limited data available after 10-12 years.

“There are no published data on the use of denosumab beyond 10 years of treatment” (JCEM 2019 – Denosumab)

If fracture risk improves (to low or moderate risk of fracture – normal or osteopenia on BMD) and transition to bisphosphonate with potential consideration of holiday is desired, can switch to bisphosphonate

• Click for bisphosphonate flowchart