What is the appropriate timing for ordering a repeat Bone Mineral Density (BMD) test for an 80-year-old female patient taking Prolia (denosumab)?

From the Research

For an 80-year-old female patient on Prolia (denosumab), a repeat bone mineral density (BMD) test should be ordered after 1-2 years of initial treatment, with subsequent testing every 2-3 years if the patient is stable. The first follow-up BMD is particularly important to confirm treatment response. For this elderly patient, consider scheduling the next BMD at the 2-year mark after starting Prolia, unless she has risk factors for rapid bone loss such as recent fractures, significant weight loss, or addition of medications that affect bone health. Prolia works by inhibiting osteoclast formation and function, thereby reducing bone resorption and increasing bone density, as shown in a study where denosumab increased bone mineral density (BMD) in postmenopausal women with osteoporosis 1. Regular BMD monitoring helps assess treatment effectiveness and guides decisions about continuing therapy. Remember that Prolia requires consistent administration every 6 months, as discontinuation without replacement therapy can lead to rapid bone loss and increased fracture risk. If the patient shows good response with stable or improved BMD, less frequent monitoring (every 2-3 years) may be appropriate for long-term follow-up. It is also important to note that denosumab can be used in patients with previous treatment, and it has been shown to increase BMD in these patients as well 2. Additionally, a study has shown that switching from teriparatide to denosumab results in continued BMD gains, whereas switching from denosumab to teriparatide results in BMD loss 3. Therefore, it is essential to carefully consider the treatment plan and monitoring schedule for each patient. Key points to consider when ordering a repeat BMD test for this patient include:

• The patient's age and menopausal status
• The presence of risk factors for rapid bone loss
• The patient's response to initial treatment with Prolia
• The need for consistent administration of Prolia every 6 months
• The potential benefits and risks of switching to other osteoporosis treatments.