A descriptive epidemiological investigation evaluating real-world practice patterns has revealed that sequential osteoporosis therapy is underutilized following the discontinuation of denosumab. Drawing upon ten years of health records from a Japanese claims database, researchers observed that only approximately 16 percent of eligible adult patients initiated sequential therapy within one year of stopping denosumab. Meanwhile, approximately half of all individuals who discontinued the medication received no subsequent osteoporosis treatment whatsoever during the same twelve-month observation window.

The primary objective of the descriptive epidemiological study was to systematically examine real-world post-discontinuation treatment sequences. Specifically, the authors aimed to quantify the rates of delayed denosumab reinitiation, the proportion of individuals who received no follow-up bone therapies, and the frequency and characteristics of sequential osteoporosis therapy. In addition, the team tracked the clinical timing of treatment changes and calculated the cumulative incidence of subsequent fragility fractures.

To investigate these patterns, the research team analyzed longitudinal claims collected between April 2014 and March 2024. The observational cohort included 37,526 adult patients aged 40 years or older who had newly initiated denosumab therapy and subsequently discontinued it after receiving at least two doses. Within the protocol, discontinuation was formally defined as the last recorded administration prior to a therapeutic gap exceeding 240 days, or a final observed drug administration followed by at least 240 days with no further record of denosumab dispensing.

Across the cohort of 37,526 eligible participants, the one-year cumulative incidence of delayed denosumab reinitiation reached 29.6 percent. Concurrently, the calculated probability of patients receiving no subsequent osteoporosis treatment over that initial year stood at 50.9 percent. The cumulative incidence of transitioning to an alternative sequential osteoporosis regimen was measured at 16.3 percent, demonstrating that approximately one in six individuals actively transitioned to another bone preservation therapy after ceasing denosumab.

For the minority of patients who transitioned to sequential osteoporosis therapy, prescription choices varied across different classes of bone medications. Oral bisphosphonates represented the most frequently administered follow-up class, accounting for 26.7 percent of sequential therapy prescriptions. Romosozumab constituted 22.2 percent of sequential therapies, followed by selective estrogen receptor modulators at 21.3 percent. Less frequently prescribed options included intravenous bisphosphonates at 15.1 percent, teriparatide at 14.6 percent, and abaloparatide, which comprised 0.1 percent of sequential regimens.

The researchers also documented distinct timing variations depending on the specific pharmacological class selected for sequential management. Overall, sequential therapy was most commonly initiated between 180 and 209 days following denosumab discontinuation. This specific timing window was especially pronounced among individuals prescribed romosozumab, where 45.7 percent initiated treatment between days 180 and 209. In contrast, selective estrogen receptor modulators were frequently initiated much earlier in the post-discontinuation window, with 39.8 percent initiated between 0 and 29 days after denosumab was stopped.

Alongside therapeutic transitions, the investigation tracked clinical outcomes across the entire study population and determined that the one-year cumulative incidence of fragility fractures was 5.4 percent. The researchers concluded that the low rate of follow-up medication and the predominance of patients receiving no subsequent therapy indicate a substantial gap in the continuity of osteoporosis care following denosumab cessation in routine clinical practice.

Subject of Research: Post-discontinuation treatment patterns and sequential therapy utilization among denosumab patients in Japan

Article Title: Real-world treatment patterns following denosumab discontinuation: a descriptive epidemiological study

Article References: Yoshiyama, T., Fukasawa, T., Masuda, S., Matsuda, S., & Kawakami, K. (2026). Real-world treatment patterns following denosumab discontinuation: a descriptive epidemiological study. Archives of Osteoporosis, 21(1), Article 162. https://doi.org/10.1007/s11657-026-01812-8

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DOI: 10.1007/s11657-026-01812-8

Keywords: denosumab, osteoporosis, sequential therapy, claims database, epidemiology, fragility fractures, oral bisphosphonates, romosozumab, selective estrogen receptor modulators, intravenous bisphosphonates, teriparatide, abaloparatide, treatment patterns, discontinuation, bone health, Japan, real-world evidence