title: Denosumab in osteoporosis.
abstract: BACKGROUND
  Denosumab is a fully human monoclonal antibody against the receptor activator of nuclear factor kappa-B ligand. It is an antiresorptive agent that reduces osteoclastogenesis.
  
  
  METHODS
  This drug evaluation reviews denosumab for use in osteoporosis. Denosumab has been shown to improve bone mineral density (BMD) and to reduce the incidence of new vertebral, hip and nonvertebral fractures in postmenopausal women. It prevents bone loss and reduces vertebral fracture risk in men with nonmetastatic prostate cancer who are receiving androgen deprivation therapy. It has also been shown to improve BMD in men with osteoporosis unrelated to androgen deprivation therapy. Safety concerns include infections, cancer, skin reactions, cardiovascular disease, hypocalcemia, osteonecrosis of the jaw and atypical femur fractures.
  
  
  CONCLUSIONS
  Although bisphosphonates are typically preferred as initial therapy for osteoporosis, denosumab could be used as initial therapy in select patients at high risk for fracture, including older patients who have difficulty with the dosing requirements of oral bisphosphonates, patients who are intolerant of or unresponsive to other therapies, and in those with impaired renal function. Additional data is needed to address issues regarding treatment duration and discontinuation, as well as to provide more information regarding denosumab's efficacy and safety.
authors.affiliation: University of Cincinnati Bone Health and Osteoporosis Center, Cincinnati VA Medical Center, Division of Endocrinology/Metabolism, Department of Internal Medicine , 260 Stetson St, Suite 4200, Cincinnati, OH 45219 , USA +1 513 558 4444 ; +1 513 558 8581 ; diabd@ucmail.uc.edu.
authors.forename: Dima L
authors.initials: DL
authors.lastname: Diab
authors.forename: Nelson B
authors.initials: NB
authors.lastname: Watts
mesh_terms: D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use*; D000069448:Denosumab; D050723:Fractures, Bone / Q000517:prevention & control; D006801:Humans; D010024:Osteoporosis / Q000188:drug therapy*
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000069448:Denosumab