Table 3.

Considerations for clinical decision-making

Supporting denosumab use

Supporting IV bisphosphonate use

Improved efficacy Better tolerability Longer time to development of moderate or severe bone pain (better prevention of pain) Safer in patients with progressive or baseline renal insufficiency Patients receiving nephrotoxic chemotherapy, ie, platinum chemotherapies Patients with diseases more susceptible to renal dysfunction (ie, prostate cancer) Patients with intolerance to bisphosphonates Patients currently receiving an IV bisphosphonate who experience an SRE Patients with elevated urinary NTx level despite bisphosphonate therapy Ease of subcutaneous administration Patients without port-a-cath or easy IV access Patients not receiving monthly chemotherapy infusion

Lower risk hypocalcemia Safer in patients unlikely to be compliant with oral vitamin D and calcium supplements Possibly lower risk ONJ Lower cost Greater than 10 years of experience with use in the medical community

Abbreviations: IV, intravenous; SRE, skeletal-related events; NTx, collagen type 1 crosslinked N-telopeptide; ONJ, osteonecrosis of the jaw.