Sublesional bone loss after acute spinal cord injury (SCI) is sudden, progressive, and
dramatic. After depletion of bone mass and the loss of architectural integrity, it may be
difficult, if even possible, to restore skeletal mass and strength. Denosumab is a relative
new, highly potent anti-resorptive agent that has proven efficacy in postmenopausal
osteoporosis to improve bone mass and in solid tumor patients to prevent a skeletal-related
event to a greater extent than that with bisphosphonate administration. In persons with
complete motor lesions, bisphosphonates have not been effective at reducing bone loss at the
knee, the site of greatest relevance because of its increased risk of fracture. Anti-RANKL
therapy appears to be more potent than bisphosphonates in animal models of bone loss due to
immobilization, suggesting that treatment with denosumab may prove to be an efficacious
therapy for persons with acute SCI to preserve bone mass and strength.