Metaphyseal band fractures in pediatric patients treated with denosumab
Authors' conclusion
Fractures through sclerotic metaphyseal bands may represent a distinct complication of denosumab therapy in children. Rebound hypercalcemia and fractures can co-occur, underscoring the need for close monitoring and management by pediatric bone specialists throughout treatment.
Study context
- Population
- Children and adolescents (aged 7–18 years) on denosumab with metaphyseal sclerotic band fractures: 4 for RANKL-mediated bone lesions, 1 for secondary osteoporosis
- Participants
- 5 children
- Outcome
- Metaphyseal sclerotic band fractures
Methodological detailsmulticentre, Bisphosphonates used variably to prevent or treat hypercalcemia
- Multicentre
- Bisphosphonates used variably to prevent or treat hypercalcemia
Main finding
As reported in the abstract
- Time from denosumab start to fracture
- 1.5-7.7 years
- Patients with rebound hypercalcemia
- 5 (all)
- Hypercalcemia episodes per patient
- 1 to >16
- Hypercalcemia preceded fracture (by 0-4 months)
- 4 cases
- First hypercalcemia 3 weeks postfracture
- 1 case
Observational data: associations, not effects.
Further findings
High-resolution peripheral quantitative computed tomography (HR-pQCT) and micro-finite element analysis (1 patient)
- Markedly increased trabecular volumetric BMD and stiffness within the sclerotic band, reduced estimated failure load
Original publication
Metaphyseal band fractures in pediatric patients treated with denosumab. Eur J Endocrinol. Published 10 November 2025. doi:10.
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