Follow-on osteoporosis therapy after denosumab discontinuation among Medicare beneficiaries
Authors' conclusion
Many patients stopping denosumab do not receive follow-on therapy.
Study context
- Population
- US Medicare beneficiaries who initiated denosumab (60 mg) 2010–2021 and discontinued it (60-day gap in use)of 120,952 denosumab initiators
- Participants
- 82,519 beneficiaries
- Outcome
- Follow-on osteoporosis therapy (oral and IV bisphosphonates, teriparatide, abaloparatide) after denosumab discontinuation
- Follow-up
- Within 1 year
Methodological details20% random sample of Medicare beneficiaries, multinomial logistic regression with marginal standardization
- 20% random sample of Medicare beneficiaries
- Multinomial logistic regression with marginal standardization
Main finding
As reported in the abstract
Initiated follow-on therapy after discontinuation
- Initiated follow-on therapy
- 4912 (6.0%)
- Mean time from discontinuation to follow-on therapy initiation, months (SD 3.4)
- 3.3
- Alendronate
- n = 3014; 3.7%
- Zoledronic acid
- n = 687; 0.8%
- Ibandronate
- n = 581; 0.7%
- Did not initiate follow-on therapy
- 43.9%
- Reinitiated denosumab after a gap
- 41.3%
- Lost to follow-up
- 8.8%
Observational data: associations, not effects.
Further findings
Predictors of follow-on therapy initiation vs no follow-on therapy
- Strong predictors: younger age (vs ≥ 85 years), female sex, prior osteoporosis therapy, 1-2 denosumab claims (vs longer therapy) before discontinuation
Original publication
Follow-on osteoporosis therapy after denosumab discontinuation among Medicare beneficiaries. Osteoporos Int. Published 27 October 2025. doi:10.
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