Therapeutic failure of denosumab in a nonagenarianpatient with postmenopausal osteoporosis: casereport and critical review of the literature

Fallo terapéutico a denosumab en unapaciente nonagenaria con osteoporosisposmenopáusica: reporte de casoy revisión crítica de la literatura

Introduction: denosumab is an antiresorptive agent widely used in postmenopausal
osteoporosis. Its efficacy in very elderly patients is not well established. Clinical case: a
93-year-old woman with osteoporosis and a history of fractures treated with denosumab
for 2 years with good adherence and a biochemical profile at target levels presented a
new vertebral fracture and a significant decrease in femoral neck BMD. Discussion:
the possibility of therapeutic failure in an adherent patient is discussed, likely related
to accumulated microstructural damage or late initiation of treatment. Clinical, pharmacological, and follow-up implications are reviewed. Conclusion: treatment failure is a
real and underdiagnosed entity. Periodic densitometric monitoring is essential, and a
change in therapeutic strategy should be considered in high-risk cases.