• Henry G Bone, Michael A Bolognese, Chui Kin Yuen, David L Kendler, Paul D Miller, Yu-Ching Yang, Luanda Grazette, Javier San Martin, and J Christopher Gallagher.
• Michigan Bone and Mineral Clinic, Detroit, Michigan 48236, USA. hgbone.md@att.net
• J. Clin. Endocrinol. Metab. 2011 Apr 1; 96 (4): 972-80.

ContextDenosumab treatment for 24 months increased bone mineral density (BMD) and reduced bone turnover markers (BTM) in postmenopausal women.ObjectiveThe aim was to determine the effects of prior denosumab or placebo injections on BMD, BTM, and safety over 24 months after treatment discontinuation.DesignWe conducted an off-treatment extension of a phase 3, randomized, double-blind, parallel-group study.ParticipantsA total of 256 postmenopausal women with a mean age of 59 yr and a mean lumbar spine T-score of -1.61 at randomization participated in the study.InterventionsParticipants received placebo or 60 mg denosumab every 6 months for 24 months, followed by 24 months off treatment.Main Outcome MeasuresWe measured the percentage changes in BMD and BTM, and evaluated safety.ResultsOf the 256 participants enrolled in the posttreatment phase, 87% completed the study. During 24 months of denosumab treatment, BMD increased (lumbar spine, 6.4%; total hip, 3.6%; 1/3 radius, 1.4%), and BTM decreased (serum C-terminal telopeptide of type 1 collagen, 63%; and N-terminal propeptide of type 1 procollagen, 47%), compared with placebo. After discontinuation, BMD declined, but the previously treated denosumab group maintained higher BMD than the previously treated placebo group at these sites (P ≤ 0.05). Final BMD at month 48 strongly correlated with month 0 BMD. After denosumab discontinuation, BTM increased above baseline within 3 months (serum C-terminal telopeptide of type 1 collagen) or 6 months (N-terminal propeptide of type 1 procollagen) and returned to baseline by month 48. Adverse event rates during the off-treatment phase were similar between groups.ConclusionsIn postmenopausal women with low BMD, the effects of 60 mg denosumab treatment for 24 months on BMD and BTM are reversible upon discontinuation, reflecting its biological mechanism of action. Residual BMD measurements remained above those of the group previously treated with placebo.

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