Bone Abstracts

Background: Osteoporosis is characterised by low bone mineral density that increases the risk of sustaining fractures. Denosumab can be an option for some individuals with renal dysfunction, and for those who are unable to tolerate or have progressed on oral bisphosphonates. The FREEDOM trial, however, has shown that discontinuation, or a delay of two months or more is associated with an increased risk of multiple vertebral fractures, usually within one year of stopping. We have also noted anecdotally and through real-world supported data that compliance and adherence with Denosumab has been suboptimal in certain patient groups such as the frail elderly.

Methods: Our study was performed retrospectively in a District General Hospital reviewing the adherence of individuals in the community to 6-monthly Denosumab injections. For patients that had discontinued Denosumab, we looked for evidence of new low-trauma fractures.

Results: Of 65 eligible patients, the median age during initial denosumab prescription was 74 years-old, showing a predominantly elderly cohort and female-to-male ratio of 61:4. There were no documented delays in 70.8% of the patients. 24.6% of patients who were started on Denosumab sustained new non-traumatic fractures with a median age of 79 years-old. Of these, 35.7% had documented delays in Denosumab. Of the 65 patients, 33.8% eventually moved on to have Zoledronic acid to seal off the bone protection effects.

Conclusion: Overall, this small study demonstrates similar findings to previous studies on increased fracture incidence in those who had delays in receiving Denosumab injections, particularly in the older population. It suggests however, that frail, older patients are at particular risk, potentially due to factors such as deteriorating mobility, cognition and accessibility. Our findings emphasise the importance of considering the inevitable deterioration in physical and mental functionality and development of co-morbidities along with access to follow-up when thinking of starting an older patient on Denosumab. It also highlights the cruciality of making patients and their close relatives, aware of the risk of fractures when the regime is not closely adhered to, allowing them to make a better-informed decision to commit to the medication, if not, alternatives will need to be explored.