Efficacy and safety of curettage with bone grafting combined with denosumab in the treatment of distal radius giant cell tumor of bone

This retrospective cohort study evaluated the efficacy and safety of combining denosumab with curettage and bone grafting for distal radius giant cell tumor of bone. Patients treated between January 2020 and June 2023 were included if aged ≥18 years with histopathologically confirmed distal radius giant cell tumor of bone, complete records, and ≥24 months of follow-up. Patients receiving curettage with bone grafting plus denosumab formed the observation group (n = 86); those receiving curettage with bone grafting plus bisphosphonates (zoledronic acid) comprised the control group (n = 78). Surgical management in both groups used extended intralesional curettage, liquid-nitrogen adjuvant inactivation, and autologous/allogeneic bone grafting under a standardized protocol. The primary functional endpoint was the modified Mayo wrist score; oncologic control was assesse d by 2-year local recurrence. Skeletal-related events (SREs) and adverse drug reactions were recorded. Baseline characteristics were comparable. At last follow-up, modified Mayo wrist score was higher with denosumab (86.74 ± 6.83 vs 81.52 ± 7.14; t = 4.784; P < .001). Two-year local recurrence was lower (8.1% vs 19.2%; χ² = 4.332; P = .037). Severe bone pain, an SRE, was less frequent with denosumab (19.77% vs 34.62%; χ² = 4.921; P = .027), while other SREs were similar between groups. Adverse drug reactions, including hypocalcemia, back pain, hypersensitivity, hypotension, influenza-like illness, and conjunctivitis, were infrequent and showed no significant intergroup differences. These findings support denosumab as an effective adjunct to intralesional surgery with a safety profile comparable to bisphosphonates.