Rethinking the role of bisphosphonates after denosumab treatment in locally advanced or unresectable aneurysmal bone cysts: A meta-analysis

Figure 4 Tentative algorithm of anti-resorptive therapy for locally advanced or inoperable aneurysmal bone cysts. ¹Immediate surgery is required in spinal tumors with instability or progressive neurological deficit; ²bisphosphonates (BPs) as definitive treatment; ³Denosumab for ≤ 6 months in an actively growing tumor; ⁴BPs to prevent rebound hypercalcemia and achieve long-term local control; ⁵Denosumab for ~ one year in an actively growing tumor; ⁶BPs to achieve long-term local control; ⁷Second-look surgery if deemed operable without high morbidity.