Skeletal-related events (SREs) are complications of bone metastases and carry a significant patient and economic burden. Denosumab is a receptor activator of nuclear factor-κB ligand (RANKL) inhibitor approved for SRE prevention in patients with multiple myeloma and patients with bone metastases from solid tumors. In phase 3 trials, denosumab showed superiority to the bisphosphonate zoledronate in reducing the risk of first on-study SRE by 17% (median time to first on-study SRE delayed by 8.2 months) and the risk of first and subsequent on-study SREs by 18% across multiple solid tumor types, including some patients with multiple myeloma. Denosumab also improved pain outcomes and reduced the need for strong opioids. Additionally, a phase 3 trial showed denosumab was noninferior to zoledronate in delaying time to first SRE in patients with newly diagnosed multiple myeloma. Denosumab has a convenient 120 mg every 4 weeks recommended dosing schedule with subcutaneous administration. Rare but serious toxicities associated with denosumab include osteonecrosis of the jaw, hypocalcemia, and atypical femoral fracture events, with multiple vertebral fractures reported following treatment discontinuation. After a decade of real-world clinical experience with denosumab, we are still learning about the optimal use and dosing for denosumab. Despite the emergence of novel and effective antitumor therapies, there remains a strong rationale for the clinical utility of antiresorptive therapy for SRE prevention. Ongoing studies aim to optimize clinical management of patients using denosumab for SRE prevention while maintaining safety and efficacy.

骨骼相关事件 (SRE) 是骨转移的并发症，会给患者和经济带来巨大负担。地诺单抗是核因子-κB 配体 (RANKL) 抑制剂的受体激活剂，获批用于多发性骨髓瘤患者和实体瘤骨转移患者的 SRE 预防。在 3 期试验中，狄诺塞麦在将首次研究 SRE 的风险降低 17%（至首次研究 SRE 的中位时间延迟 8.2 个月）以及首次和后续研究 SRE 的风险方面显示优于双膦酸盐唑来膦酸盐在多种实体瘤类型中增加了 18%，包括一些多发性骨髓瘤患者。地诺单抗还改善了疼痛结果并减少了对强效阿片类药物的需求。此外，一项 3 期试验显示，在新诊断的多发性骨髓瘤患者中，地诺单抗在延迟首次 SRE 时间方面不劣于唑来膦酸盐。地诺单抗有一个方便的 120 mg 每 4 周推荐给药方案，皮下给药。与狄诺塞麦相关的罕见但严重的毒性包括下颌骨坏死、低钙血症和非典型股骨骨折事件，在停药后报告多处椎骨骨折。经过十年真实世界的地诺单抗临床经验，我们仍在了解地诺单抗的最佳使用和剂量。尽管出现了新的和有效的抗肿瘤疗法，但抗吸收疗法在 SRE 预防中的临床应用仍然有很强的理由。