{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T10:47:09Z","timestamp":1782298029083,"version":"3.54.5"},"reference-count":28,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T00:00:00Z","timestamp":1782259200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T00:00:00Z","timestamp":1782259200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Internal Medicine Journal"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Denosumab is a highly effective therapy for osteoporosis. Since its approval by the Therapeutic Goods Administration (TGA) in 2010, use of denosumab has surged across Australia, delivering substantial fracture\u2010prevention benefits to tens of thousands of patients. However, stopping denosumab may lead to acute loss of bone with an increased risk of fractures. Increasing awareness of this so\u2010called \u2018rebound phenomenon\u2019 has created fear and concern among consumers and prescribers. A recent TGA safety update in November 2025 has raised further concern regarding the risk of spontaneous vertebral fractures in patients ceasing denosumab. This Viewpoint aims to interpret the latest updates in the context of current evidence, examine why Australia is particularly vulnerable to misinterpretation of these warnings and provide practical guidance to support safe, evidence\u2010based management of denosumab use in Australian practice.<\/jats:p>","DOI":"10.1111\/imj.70519","type":"journal-article","created":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T09:56:27Z","timestamp":1782294987000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Denosumab discontinuation and fracture risk: getting the balance right"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5832-0224","authenticated-orcid":false,"given":"Albert S.","family":"Kim","sequence":"first","affiliation":[{"name":"Department of Endocrinology Westmead Hospital  Sydney New South Wales Australia"},{"name":"Sydney Medical School, Faculty of Medicine and Health University of Sydney  Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8746-5529","authenticated-orcid":false,"given":"Christian M.","family":"Girgis","sequence":"additional","affiliation":[{"name":"Department of Endocrinology Westmead Hospital  Sydney New South Wales Australia"},{"name":"Sydney Medical School, Faculty of Medicine and Health University of Sydney  Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,6,24]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"crossref","first-page":"756","DOI":"10.1056\/NEJMoa0809493","article-title":"Denosumab for prevention of fractures in postmenopausal women with osteoporosis","volume":"361","author":"Cummings SR","year":"2009","journal-title":"N Engl J Med"},{"key":"e_1_2_9_3_1","doi-asserted-by":"crossref","first-page":"513","DOI":"10.1016\/S2213-8587(17)30138-9","article-title":"10\u2009years of denosumab treatment in postmenopausal women with osteoporosis: results from the phase 3 randomised FREEDOM trial and open\u2010label extension","volume":"5","author":"Bone HG","year":"2017","journal-title":"Lancet Diabetes Endocrinol"},{"key":"e_1_2_9_4_1","doi-asserted-by":"crossref","first-page":"317","DOI":"10.1007\/s00198-011-1780-1","article-title":"Final results of the DAPS (Denosumab adherence preference satisfaction) study: a 24\u2010month, randomized, crossover comparison with alendronate in postmenopausal women","volume":"23","author":"Freemantle N","year":"2012","journal-title":"Osteoporos Int"},{"key":"e_1_2_9_5_1","volume-title":"Denosumab for Osteoporosis: Utilisation Analysis Using PBS Data","author":"Drug Utilisation Sub\u2010Committee (DUSC)","year":"2020"},{"key":"e_1_2_9_6_1","doi-asserted-by":"crossref","DOI":"10.1007\/s11657-022-01139-0","article-title":"Trends in osteoporosis diagnosis and management in Australia","volume":"17","author":"Smith L","year":"2022","journal-title":"Arch Osteoporos"},{"key":"e_1_2_9_7_1","doi-asserted-by":"crossref","DOI":"10.18773\/austprescr.2024.048","article-title":"Top 10 drugs 2023\u201324","volume":"47","author":"NPS MedicineWise","year":"2024","journal-title":"Aust Prescr"},{"key":"e_1_2_9_8_1","unstructured":"Bohingamu MudiyanselageS WattsJ GebremariamK Abimanyi\u2010OchomJ.Osteoporosis and fractures in Australia. A burden of disease analysis 2023 to 2033.2024. Available from URL:https:\/\/healthybonesaustralia.org.au\/wp-content\/uploads\/2024\/09\/bod-2024-digital-isbn-final.pdf."},{"key":"e_1_2_9_9_1","doi-asserted-by":"crossref","first-page":"887","DOI":"10.1080\/14712598.2025.2540471","article-title":"Biosimilars in osteoporosis treatment: focus on denosumab","volume":"25","author":"Aapro M","year":"2025","journal-title":"Expert Opin Biol Ther"},{"key":"e_1_2_9_10_1","doi-asserted-by":"crossref","first-page":"1291","DOI":"10.1002\/jbmr.3110","article-title":"Clinical features of 24 patients with rebound\u2010associated vertebral fractures after Denosumab discontinuation: systematic review and additional cases","volume":"32","author":"Anastasilakis AD","year":"2017","journal-title":"J Bone Miner Res"},{"key":"e_1_2_9_11_1","doi-asserted-by":"crossref","first-page":"2112","DOI":"10.1002\/jbmr.4705","article-title":"Multiple vertebral fractures after Denosumab discontinuation: FREEDOM and FREEDOM extension trials additional post hoc analyses","volume":"37","author":"Cosman F","year":"2022","journal-title":"J Bone Miner Res"},{"key":"e_1_2_9_12_1","unstructured":"TimmsP.Some Australian patients say they're not being adequately warned about side effects of osteoporosis drug Prolia 2024. Available from URL:https:\/\/www.abc.net.au\/news\/2024-10-31\/osteoporosis-patient-concerns-prolia-side-effects\/104526752."},{"key":"e_1_2_9_13_1","doi-asserted-by":"crossref","first-page":"484","DOI":"10.1093\/jbmr\/zjae023","article-title":"Temporal patterns of osteoclast formation and activity following withdrawal of RANKL inhibition","volume":"39","author":"Kim AS","year":"2024","journal-title":"J Bone Miner Res"},{"key":"e_1_2_9_14_1","doi-asserted-by":"crossref","first-page":"1723","DOI":"10.1007\/s00198-017-3919-1","article-title":"Observations following discontinuation of long\u2010term denosumab therapy","volume":"28","author":"McClung MR","year":"2017","journal-title":"Osteoporos Int"},{"key":"e_1_2_9_15_1","doi-asserted-by":"crossref","DOI":"10.1093\/jbmr\/zjaf037","article-title":"Denosumab discontinuation in the clinic: implications of rebound bone turnover and emerging strategies to prevent bone loss and fractures","volume":"40","author":"Kumar S","year":"2025","journal-title":"J Bone Miner Res"},{"key":"e_1_2_9_16_1","doi-asserted-by":"crossref","first-page":"413","DOI":"10.1093\/jbmr\/zjaf008","article-title":"Early and multiple doses of zoledronate mitigates rebound bone loss following withdrawal of RANKL inhibition","volume":"40","author":"Kim AS","year":"2025","journal-title":"J Bone Miner Res"},{"key":"e_1_2_9_17_1","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1186\/s12875-020-01103-2","article-title":"Osteoporosis management in Australian general practice: an analysis of current osteoporosis treatment patterns and gaps in practice","volume":"21","author":"Naik\u2010Panvelkar P","year":"2020","journal-title":"BMC Fam Pract"},{"key":"e_1_2_9_18_1","unstructured":"Strengthened warnings for fracture risk after discontinuation of denosumab (Prolia and biosimilars) Canberra: Therapeutic Goods Administration (TGA);2025Available from 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