Real-world rebound pattern of serum collagen type I C-telopeptide after denosumab discontinuation and zoledronate rescue in postmenopausal osteoporosis and cancer treatment-induced bone loss
Authors' conclusion
In real-world practice, bone resorption rebounds after Dmab discontinuation in a reproducible, nonlinear pattern despite ZOL rescue, peaking around 6-9 months.
Study context
- Population
- Women who received a single 5-mg zoledronate (ZOL) infusion 6 months after denosumab discontinuation
- Participants
- 65 women
- Exposure
- Postmenopausal osteoporosis (PMO) vs cancer treatment-induced bone loss (CTIBL): s-CTX-I trajectories after denosumab discontinuation and single zoledronate rescue
- PMOn = 30
- CTIBLn = 35
- Outcome
- Continuous s-CTX-I trajectories after Dmab withdrawal and ZOL rescue, and rebound profiles PMO vs CTIBL
- Follow-up
- 30 to +360 days relative to ZOL
Methodological detailsreal-world, linear mixed-effects regression with natural cubic splines, adjusted for age and denosumab (Dmab) duration
- Real-world
- Linear mixed-effects regression with natural cubic splines
- Adjusted for age and Dmab duration
Main finding
As reported in the abstract
s-CTX-I trajectory after ZOL
- Spline model fit better than linear specification (ΔAIC)
- > 20
Observational data: associations, not effects.
Further findings
Rebound intensity (Δs-CTX-I) vs % bone mineral density (BMD) gain at lumbar spine, femoral neck or total hip during Dmab
- Not associated
Safety
Vertebral fracture during follow-up
- Vertebral fractures
- 1
Original publication
Real-world rebound pattern of serum collagen type I C-telopeptide after denosumab discontinuation and zoledronate rescue in postmenopausal osteoporosis and cancer treatment-induced bone loss. Osteoporos Int. Published 6 March 2026. doi:10.
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