What is the recommended approach when stopping denosumab to prevent rebound bone loss?

• A. Transition to another antiresorptive therapy to prevent rebound bone loss
• B. No transition needed; stop abruptly
• C. Immediately start a calcium supplement only
• D. Double the estrogen therapy

Answer: (B)

Stopping denosumab requires a plan to prevent rebound bone loss because once its effect wears off, bone turnover surges and bone density can fall quickly, increasing fracture risk. The best approach is to transition to another antiresorptive therapy, typically a bisphosphonate such as zoledronic acid or alendronate, started soon after the last denosumab dose. This bridging helps maintain suppression of bone resorption during the period when denosumab is waning, reducing the chance of rapid bone loss and vertebral fractures. While ensuring adequate calcium and vitamin D is important for overall bone health, calcium alone won’t stop the rebound. Doubling estrogen therapy isn’t an appropriate or effective strategy for preventing rebound bone loss in this context.