We read with great interest in Journal of Clinical Oncology the ASCO Clinical Practice Guideline by Shapiro et al¹ on the management of osteoporosis in survivors of adult cancers with nonmetastatic disease. We are concerned by the limited information given about the risk of multiple spontaneous vertebral fractures (MSVFs) at denosumab discontinuation. The recommendations and the discussion should address two major safety concerns regarding denosumab discontinuation: (1) the increased risk of MSVF, and (2) the need to prescribe a bisphosphonate according to a strict regimen to limit this risk.

中文翻译：

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必须考虑在Denosumab停药时发生多发性自发性骨折的风险增加。

我们非常感兴趣地阅读了《临床肿瘤学杂志》（由Shapiro等人¹撰写的ASCO临床实践指南），探讨了成年癌非转移性疾病幸存者中骨质疏松症的管理。我们对有关地诺单抗终止时多发性自发性脊椎骨折（MSVFs）风险的有限信息感到关注。建议和讨论应解决有关地诺单抗停药的两个主要安全问题：（1）MSVF风险增加，以及（2）必须按照严格的方案开具双膦酸盐以限制这种风险。