We thank Gonzalez-Rodriguez et al¹ for pointing out the important risks of multiple spontaneous (atraumatic) vertebral fractures (MSVFs) that are due to denosumab discontinuation. Because of risks of MSVF, they disagree with recommendation 3.4 in the ASCO Clinical Practice Guideline regarding the use of oral and intravenous bisphosphonates or denosumab as treatment options for individuals with nonmetastatic cancer and osteoporosis or increased risk of osteoporotic fractures based on clinical factors.² Gonzalez-Rodriguez et al¹ argue in favor of bisphosphonates as the initial treatment, with denosumab being considered as second-line treatment. They further state that for denosumab, “A first-line prescription should be exceptional, discussed with the patient, and ideally left to the responsibility of a specialist in bone pathologies.”¹ To address the concerns raised by Gonzalez-Rodriguez et al¹, the risks of MSVF as best as can be determined and an informal risk (of MSVF) to benefit (reductions in fractures) analysis of denosumab is presented.

中文翻译：

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回复E. Gonzalez-Rodriguez等。

我们感谢Gonzalez-Rodriguez等人¹指出了由于denosumab停药导致的多发性（无创）椎体骨折（MSVF）的重要风险。由于存在MSVF的风险，他们不同意ASCO临床实践指南中关于使用口服和静脉注射双膦酸盐或denosumab作为非转移性癌症和骨质疏松症患者或因临床因素而增加骨质疏松性骨折风险的治疗选择的建议3.4。²冈萨雷斯-罗德里格斯等人¹主张使用双膦酸盐类药物作为初始治疗，将地诺单抗视为二线治疗。他们进一步指出，对于denosumab而言，“一线处方应是特殊的，应与患者讨论，最好由骨病理学专家负责。” ¹为解决Gonzalez-Rodriguez等[ ^1]提出的问题，尽力确定了MSVF的风险，并提出了对denosumab分析有益的（MSVF的）非正式风险（减少骨折）。