the rank-l inhibitor
A monoclonal antibody that inhibits osteoclast maturation.
indications & dosing
- Osteoporosis (Prolia): 60 mg SC every 6 months.
- Bone Metastases / Myeloma (Xgeva): 120 mg SC every 4 weeks.
- Advantage: Superior to Zoledronic Acid for preventing skeletal events. No renal adjustment (Safe in CKD).
adverse effects
- Hypocalcaemia: High risk. Must supplement Ca/Vit D.
- ONJ (Osteonecrosis of the Jaw): Similar risk to bisphosphonates.
- Rebound Vertebral Fractures:
- Critical: If stopped, bone turnover “rebounds” massively, leading to multiple vertebral fractures.
- Rule: Never stop Denosumab without transitioning to a Bisphosphonate to “seal” the bone density.