Bone Health ECHO Case Report: Significant Elevation in Bone Turnover Markers and Progression of Vertebral Fractures After Denosumab Discontinuation Followed by a PTH-Analog

Bone Health ECHO (Extension for Community Healthcare Outcomes) is a virtual community of practice, where healthcare professionals have met via videoconferencing weekly since 2015. This model of learning is focused on short didactics and the presentation of real but de-identified patient cases followed by highly interactive discussions. These are often clinical situations with diagnostic and therapeutic dilemmas that are not readily addressed by randomized placebo-controlled clinical trials and clinical practice guidelines. Here we present the case of a woman with postmenopausal osteoporosis with adverse consequences following discontinuation of denosumab and uncertainties on next steps for management. This case highlights the relevance of selection of the initial bone-targeted medication and the sequence of therapy in osteoporosis management.