A 66-year-old postmenopausal woman with a hip T-score of -3.1 cannot tolerate oral bisphosphonates because of reflux oesophagitis. Which agent is given as a 60 mg subcutaneous injection once every six months?
- A Denosumab ✓
- B Teriparatide
- C Salmon calcitonin
- D Raloxifene
Correct answer: A. Denosumab
Explanation
Denosumab is a fully human monoclonal antibody against RANKL. It blocks osteoclast formation, activation and survival, and is dosed as 60 mg subcutaneously every six months. It reduces both vertebral and non-vertebral fractures and needs no renal adjustment, unlike bisphosphonates. Teriparatide is a daily injection, raloxifene is oral, and calcitonin is weak and mainly analgesic. B recognised hazard of denosumab is severe rebound hypercalcaemia and rapid bone loss if doses are stopped without follow-on therapy.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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