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Adverse drug events of denosumab: Data-mining based on the United States Food and Drug Administration Adverse Event Reporting System database

Year 2024, Volume: 28 Issue: 4, 1220 - 1230, 28.06.2025

Abstract

Objective: This study seeks to analyze data from the United States (U.S.) Food and Drug Administration Adverse Event Reporting System (FAERS) to identify potential adverse drug event (ADE) signals associated with denosumab and provide valuable insights into the clinical safety of denosumab usage. Methods: Data on denosumab- related ADEs reported from the FAERS between the second quarter of 2010 to the first quarter of 2022 were extracted using OpenVigil 2.1. The Reporting Odds Ratio (ROR) and Proportional Reporting Ratio (PRR) were calculated as measures to detect potential ADE signals. Results: The analysis of FAERS data uncovers potential ADE signals associated with the use of denosumab. These signals encompass a spectrum of adverse effects, including well- established risks such as musculoskeletal pain, hypocalcemia, and osteonecrosis of the jaw. Moreover, novel potential adverse events emerge, including oral diseases, fractures occurring in various locations, and signals indicating tumors beyond the drug's approved indications. Conclusions: This study highlights the significance of closely monitoring patients for potential adverse events during denosumab treatment. Healthcare professionals should exercise heightened vigilance for the development of oral diseases, fractures, and tumors in individuals receiving denosumab therapy. The identification of these additional ADE signals should inform clinical decision-making, patient risk assessments, and ongoing efforts in pharmacovigilance, thereby ensuring the safe and effective utilization of denosumab.

References

  • [1] Lacey DL, Boyle WJ, Simonet WS, Kostenuik PJ, Dougall WC, Sullivan JK, San Martin J, Dansey R. Bench to bedside: elucidation of the OPG-RANK-RANKL pathway and the development of denosumab. Nat Rev Drug Discov. 2012; 11 (5):401-419. https://doi.org/10.1038/nrd3705
  • [2] Dell'Aquila E, Armento G, Iuliani M, Simonetti S, D'Onofrio L, Zeppola T, Madaudo C, Russano M, Citarella F, Ribelli G, Pantano F, Vincenzi B, Tonini G, Santini D. Denosumab for cancer-related bone loss. Expert Opin Biol Ther. 2020; 20 (11):1261-1274. https://doi.org/10.1080/14712598.2020.1814731
  • [3] Zaheer S, LeBoff M, Lewiecki EM. Denosumab for the treatment of osteoporosis. Expert Opin Drug Metab Toxicol. 2015; 11 (3):461-470. https://doi.org/10.1517/17425255.2015.1000860
  • [4] Kanis JA, Cooper C, Rizzoli R, Reginster JY. European guidance for the diagnosis and management of osteoporosis in postmenopausal women. Osteoporos Int. 2019; 30 (1):3-44. https://doi.org/10.1007/s00198-018-4704-5
  • [5] Shoback D, Rosen CJ, Black DM, Cheung AM, Murad MH, Eastell R. Pharmacological management of osteoporosis in postmenopausal women: An endocrine society guideline update. J Clin Endocrinol Metab. 2020; 105 (3): dgaa048. https://doi.org/10.1210/clinem/dgaa048
  • [6] Watts NB, Camacho PM, Lewiecki EM, Petak SM. American Association of Clinical Endocrinologists/American College of Endocrinology Clinical Practice Guidelines for the diagnosis and treatment of postmenopausal osteoporosis-2020 Update. Endocr Pract. 2021; 27 (4):379-380. https://doi.org/10.1016/j.eprac.2021.02.001
  • [7] Bone HG, Wagman RB, Brandi ML, Brown JP, Chapurlat R, Cummings SR, Czerwiński E, Fahrleitner-Pammer A, Kendler DL, Lippuner K, Reginster JY, Roux C, Malouf J, Bradley MN, Daizadeh NS, Wang A, Dakin P, Pannecciulli N, Dempster WD, Papapoulos S. 10 years of denosumab treatment in postmenopausal women with osteoporosis: results from the phase 3 randomised FREEDOM trial and open-label extension. Lancet Diabetes Endocrinol. 2017; 5 (7):513-523. https://doi.org/10.1016/s2213-8587(17)30138-9
  • [8] Cummings SR, San Martin J, McClung MR, Siris ES, Eastell R, Reid IR, Delmas P, Zoog HB, Austin M, Wang A, Kutilek S, Adami S, zanchetta J, Libanati C, Siddhanti S, Christiansen C. Denosumab for prevention of fractures in postmenopausal women with osteoporosis. N Engl J Med. 2009; 361 (8):756-765. https://doi.org/10.1056/NEJMoa0809493
  • [9] Nicolatou-Galitis O, Schiødt M, Mendes RA, Ripamonti C, Hope S, Drudge-Coates L, Niepel D, Van den Wyngaert T. Medication-related osteonecrosis of the jaw: Definition and best practice for prevention, diagnosis, and treatment. Oral Surg Oral Med Oral Pathol Oral Radiol. 2019; 127 (2):117-135. https://doi.org/10.1016/j.oooo.2018.09.008
  • [10] Kendler DL, Cosman F, Stad RK, Ferrari S. Denosumab in the treatment of osteoporosis: 10 Years Later: A narrative review. Adv Ther. 2022; 39 (1):58-74. https://doi.org/10.1007/s12325-021-01936-y
  • [11] FAERS, FDA's Adverse Event Reporting System. https://www.fda.gov/drugs/surveillance/questions-and-answers-fdas-adverse-event-reporting-system-faers (accessed on 4 January 2023).
  • [12] Subeesh V, Maheswari E, Singh H, Beulah TE, Swaroop AM. Novel adverse events of ıloperidone: A disproportionality analysis in US Food and Drug Administration Adverse Event Reporting System (FAERS) Database. Curr Drug Saf. 2019; 14 (1):21-26. https://doi.org/10.2174/1574886313666181026100000
  • [13] Watts NB, Grbic JT, Binkley N, Papapoulos S, Butler PW, Yin X, Tierney A, Wagman RB, McClung M. Invasive oral procedures and events in postmenopausal women with osteoporosis treated with denosumab for up to 10 years. J Clin Endocrinol Metab. 2019; 104 (6):2443-2452. https://doi.org/10.1210/jc.2018-01965
  • [14] Tsvetov G, Amitai O, Shochat T, Shimon I, Akirov A, Diker-Cohen T. Denosumab-induced hypocalcemia in patients with osteoporosis: can you know who will get low? Osteoporos Int. 2020; 31 (4):655-665. https://doi.org/10.1007/s00198-019-05261-7
  • [15] Li Y, Fan CY, Manni A, Simonds WF. Pitfalls of using denosumab preoperatively to treat refractory severe hypercalcaemia. BMJ Case Rep. 2020; 13 (4): e233665. https://doi.org/10.1136/bcr-2019-233665
  • [16] Huynh AL, Baker ST, Stewardson AJ, Johnson DF. Denosumab-associated hypocalcaemia: incidence, severity and patient characteristics in a tertiary hospital setting. Pharmacoepidemiol Drug Saf. 2016; 25 (11):1274-1278. https://doi.org/10.1002/pds.4045
  • [17] Horiuchi K, Kobayashi E, Mizuno T, Susa M, Chiba K. Hypercalcemia following discontinuation of denosumab therapy: A systematic review. Bone Rep. 2021; 15 101148. https://doi.org/10.1016/j.bonr.2021.101148
  • [18] Zhou Z, Chen C, Zhang J, Ji X, Liu L, Zhang G, Cao X, Wang P. Safety of denosumab in postmenopausal women with osteoporosis or low bone mineral density: a meta-analysis. Int J Clin Exp Pathol. 2014; 7 (5):2113-2122.
  • [19] Schiodt M, Larsson Wexell C, Herlofson BB, Giltvedt KM, Norholt SE, Ehrenstein V. Existing data sources for clinical epidemiology: Scandinavian Cohort for osteonecrosis of the jaw - work in progress and challenges. Clin Epidemiol. 2015; 7 107-116. https://doi.org/10.2147/clep.S71796
  • [20] Chang J, Hakam AE, McCauley LK. Current understanding of the pathophysiology of osteonecrosis of the jaw. Curr Osteoporos Rep. 2018; 16 (5):584-595. https://doi.org/10.1007/s11914-018-0474-4
  • [21] Yarom N, Lazarovici TS, Whitefield S, Weissman T, Wasserzug O, Yahalom R. Rapid onset of osteonecrosis of the jaw in patients switching from bisphosphonates to denosumab. Oral Surg Oral Med Oral Pathol Oral Radiol. 2018; 125 (1):27-30. https://doi.org/10.1016/j.oooo.2017.09.014
  • [22] Kuroshima S, Al-Salihi Z, Yamashita J. Mouse anti-RANKL antibody delays oral wound healing and increases TRAP-positive mononuclear cells in bone marrow. Clin Oral Investig. 2016; 20 (4):727-736. https://doi.org/10.1007/s00784-015-1550-0
  • [23] Ekholm HM, Löyttyniemi E, Soukka T, Rautava J. Gingival cell growth with antiresorptive treatment combined with corticosteroids or antiestrogen. Clin Exp Dent Res. 2021; 7 (4):465-473. https://doi.org/10.1002/cre2.382
  • [24] Beth-Tasdogan NH, Mayer B, Hussein H, Zolk O, Peter JU. Interventions for managing medication-related osteonecrosis of the jaw. Cochrane Database Syst Rev. 2022; 7 (7):Cd012432. https://doi.org/10.1002/14651858.CD012432.pub3
  • [25] Chawla S, Blay JY, Rutkowski P, Le Cesne A, Reichardt P, Gelderblom H, Grimer RJ, Choy E, Skubitz K, Seeger L, Schuetze SM, Henshaw R, Dai T, Jandial D, Palmerini E. Denosumab in patients with giant-cell tumour of bone: A multicentre, open-label, phase 2 study. Lancet Oncol. 2019; 20 (12):1719-1729. https://doi.org/10.1016/s1470-2045(19)30663-1
  • [26] Thomas D, Henshaw R, Skubitz K, Chawla S, Staddon A, Blay JY, Roudier M, Smith J, Ye Z, Sohn W, Dansey R, jun S. Denosumab in patients with giant-cell tumour of bone: an open-label, phase 2 study. Lancet Oncol. 2010; 11 (3):275-280. https://doi.org/10.1016/s1470-2045(10)70010-3
  • [27] Errani C, Tsukamoto S, Leone G, Righi A, Akahane M, Tanaka Y, Donati DM. Denosumab May Increase the risk of local recurrence in patients with giant-cell tumor of bone treated with curettage. J Bone Joint Surg Am. 2018; 100 (6):496-504. https://doi.org/10.2106/jbjs.17.00057
  • [28] Errani C, Tsukamoto S, Mavrogenis AF. How safe and effective is denosumab for bone giant cell tumour? Int Orthop. 2017; 41 (11):2397-2400. https://doi.org/10.1007/s00264-017-3536-9
  • [29] Rutkowski P, Gaston L, Borkowska A, Stacchiotti S, Gelderblom H, Baldi GG, Palmerini E, Casali P, Gronchi A, Parry M, Domenico AC, Scoccianti G, Waqrodzki M, Ferrai S, Diikstra S, Pienkowski A, Grimer R. Denosumab treatment of inoperable or locally advanced giant cell tumor of bone - Multicenter analysis outside clinical trial. Eur J Surg Oncol. 2018; 44 (9):1384-1390. https://doi.org/10.1016/j.ejso.2018.03.020
  • [30] Alomar M, Tawfiq AM, Hassan N, Palaian S. Post marketing surveillance of suspected adverse drug reactions through spontaneous reporting: current status, challenges and the future. Ther Adv Drug Saf. 2020; 11 2042098620938595. https://doi.org/10.1177/2042098620938595
  • [31] Moore N, Thiessard F, Begaud B. The history of disproportionality measures (reporting odds ratio, proportional reporting rates) in spontaneous reporting of adverse drug reactions. Pharmacoepidemiol Drug Saf. 2005; 14 (4):285-286. https://doi.org/10.1002/pds.1058
There are 31 citations in total.

Details

Primary Language English
Subjects Clinical Pharmacology and Therapeutics
Journal Section Articles
Authors

Shaohua Liu 0000-0003-1448-3827

Wangyan Jiang 0000-0001-8445-5632

Jieru Guo 0000-0001-8275-2828

Xinrong Zhou 0009-0001-1427-6249

Zhelong Liu 0000-0003-2567-2287

Publication Date June 28, 2025
Published in Issue Year 2024 Volume: 28 Issue: 4

Cite

APA Liu, S., Jiang, W., Guo, J., Zhou, X., et al. (2025). Adverse drug events of denosumab: Data-mining based on the United States Food and Drug Administration Adverse Event Reporting System database. Journal of Research in Pharmacy, 28(4), 1220-1230.
AMA Liu S, Jiang W, Guo J, Zhou X, Liu Z. Adverse drug events of denosumab: Data-mining based on the United States Food and Drug Administration Adverse Event Reporting System database. J. Res. Pharm. July 2025;28(4):1220-1230.
Chicago Liu, Shaohua, Wangyan Jiang, Jieru Guo, Xinrong Zhou, and Zhelong Liu. “Adverse Drug Events of Denosumab: Data-Mining Based on the United States Food and Drug Administration Adverse Event Reporting System Database”. Journal of Research in Pharmacy 28, no. 4 (July 2025): 1220-30.
EndNote Liu S, Jiang W, Guo J, Zhou X, Liu Z (July 1, 2025) Adverse drug events of denosumab: Data-mining based on the United States Food and Drug Administration Adverse Event Reporting System database. Journal of Research in Pharmacy 28 4 1220–1230.
IEEE S. Liu, W. Jiang, J. Guo, X. Zhou, and Z. Liu, “Adverse drug events of denosumab: Data-mining based on the United States Food and Drug Administration Adverse Event Reporting System database”, J. Res. Pharm., vol. 28, no. 4, pp. 1220–1230, 2025.
ISNAD Liu, Shaohua et al. “Adverse Drug Events of Denosumab: Data-Mining Based on the United States Food and Drug Administration Adverse Event Reporting System Database”. Journal of Research in Pharmacy 28/4 (July 2025), 1220-1230.
JAMA Liu S, Jiang W, Guo J, Zhou X, Liu Z. Adverse drug events of denosumab: Data-mining based on the United States Food and Drug Administration Adverse Event Reporting System database. J. Res. Pharm. 2025;28:1220–1230.
MLA Liu, Shaohua et al. “Adverse Drug Events of Denosumab: Data-Mining Based on the United States Food and Drug Administration Adverse Event Reporting System Database”. Journal of Research in Pharmacy, vol. 28, no. 4, 2025, pp. 1220-3.
Vancouver Liu S, Jiang W, Guo J, Zhou X, Liu Z. Adverse drug events of denosumab: Data-mining based on the United States Food and Drug Administration Adverse Event Reporting System database. J. Res. Pharm. 2025;28(4):1220-3.