PDSA practice guide Up to 9 CPD hrs

Prolia (denosumab) recall management

Denosumab (Prolia) has no residual activity once a dose is delayed or missed. Bone turnover rebounds rapidly and bone mineral density gains are quickly reversed, with vertebral fracture risk nearly quadrupling beyond a 16-week delay. Keeping every patient within the 6-month dosing window depends on a reliable recall system.

AuthorDr Chris Mitchell AM

CPD hoursUp to 9 CPD hrs

CycleOne quarter, Plan-Do-Study-Act

The cycle identifies overdue patients through database search, works the backlog, compares phone contact against automated recall for this patient group, and installs the reminder-at-time-of-administration protocol that stops the backlog rebuilding. The worked example recovers a backlog of 66 overdue patients across three monthly cycles.

What the guide covers

Recall recovery

Finding overdue patients by database search, working through the backlog, and the comparison of phone contact against automated recall for this patient group.

Preventing recurrence

The reminder-at-time-of-administration protocol, the at-injection checklist, reminder cards and the monthly overdue search that stops the backlog growing again.

Clinical knowledge base

Denosumab mechanism, indications, contraindications, monitoring, discontinuation and transition therapy, dental extraction timing and patient education.

CPD hours from this cycle

Up to 9 hours per participating GP when submitted as a practice-based or group activity: 3 hours educational activities, 3 hours reviewing performance, 3 hours measuring outcomes. Nurses record their participation toward the NMBA 20-hour requirement. A certified practice manager can claim the coordination work as professional development, on AAPM's conditions. The completed workbook is the supporting evidence.

Educational activities (3 hrs): Denosumab management, fracture risk evidence and the practice knowledge base.
Reviewing performance (3 hrs): Overdue Prolia recalls reviewed against the dosing schedule, with recovery targets set.
Measuring outcomes (3 hrs): Overdue recalls tracked across three monthly cycles, confirming the trend holds.

CPD figures verified against the guide and the CPD home handbooks, 15 July 2026.

Patient safety and continuity

Patient safety

Keeping every patient inside the 6-month window prevents the rapid bone loss and rebound vertebral fractures that follow missed or delayed doses.

Continuity and billing

Consistent recall supports GP Chronic Condition Management Plan review where appropriate, nurse monitoring under MBS item 10997 and fewer missed appointments.

Key topics

Delayed dosing and rebound fracture risk
Overdue recall identification and recovery
Reminder systems and the at-injection checklist
Discontinuation and transition therapy
MRONJ and dental extraction timing

Who this is for

Practice managers and nurses responsible for recall systems, reminder protocols and chronic disease billing
GP practice owners and GPs recovering an overdue Prolia backlog, with a documented CPD outcome
The whole team: reception holds the reminder card step, nursing holds the at-injection checklist

Choose your format

Open the interactive workbook

Type into it as you go; saves on your computer

Read the guide

Read online, print to PDF for your records

Download the PDF

A4 PDF for printing or your records

Author: Dr Chris Mitchell AM, FAICD, general practitioner and co-founder of Medius Global. This guide documents cycles run in his own practice. Editorial and review process.