When stopping denosumab and transitioning to PO bisphosphonate, do you wait for 6 months after the last denosumab injection to start PO bisphosphonate?

Some background: In patients discontinuing denosumab without subsequent antiresorptive therapy, BMD rapidly reverts back to baseline with an elevation in vertebral fracture risk (with an enhanced risk of multiple vertebral fractures). Thus, sequential treatment regimens following denosumab have been studied for their effectiveness (both timing and different agents) in attenuating the rebound phenomenon and its clinical consequences. Duration of denosumab exposure is the single greatest clinical ...

It is only recommended to stop denosumab if the patient fractures on therapy, develops ONJ, has an AFF, or has an intolerable adverse event. If the patient has any of these (except for an intolerable adverse event), it is not recommended to switch to a bisphosphonate but rather to romosozumab for one year, followed by a therapy not associated with an AFF or ONJ. If the patient stops denosumab due to the intolerable adverse event or problem with receiving an every 6-month injection, such as with ...