A related editorial discussed this study. Given the need for long-term treatment in many people with osteoporosis, this evidence that the safety profile of denosumab remains stable over many years in an ageing population is important. However, by contrast to bisphosphonates, cessation of denosumab is followed by rapid bone loss and an increase in the rate of vertebral fractures therefore, if treatment is discontinued, patients should be switched to an alternative therapy. The optimal duration of therapy with any intervention is a major focus of current research, and safety is a key issue in determining the benefit–risk balance.