Rationalising bisphosphonates and denosumab used for osteoporosis in palliative care
Follow the principles of medication rationalisation when deprescribing bisphosphonates and denosumab in palliative care.
Bisphosphonates are retained in the skeleton for at least a year after treatment is stopped. Consider stopping bisphosphonates used for osteoporosis in the last year of life, particularly if duration of therapy has been longer than 3 years—see the Bone and Metabolism guidelines for further details.
Unlike bisphosphonates, which have a long skeletal half-life, stopping denosumab leads to a rapid increase in bone turnover and loss of bone mineral density (BMD). If a patient is on denosumab for osteoporosis, therapy should be continued indefinitely if the patient is not experiencing adverse effects (at the time of writing, the use of denosumab for more than 10 years has not been studied), or be replaced with bisphosphonate therapy if stopped to prevent rapid bone loss and vertebral fracture—see the Bone and Metabolism guidelines for further details.