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Case contributed by Dato’ Dr Lee Joon Kiong, Consultant Orthopaedic Surgeon, Beacon Hospital, Malaysia
Patient information
Age: 70 years
Sex: Female
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History
Presenting complaint
Patient presented to the clinic with bilateral hip pain
- Disturbed functional status
- Walked with a limp
- Unable to stand or walk continuously for a long period
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Physical Examination
Bilateral hips
- Gross limited range of movement of both hips
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Investigation
Bilateral hip X-ray
- X-ray showed bilateral hip osteoarthritis
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Treatment
Pre-operative
- Patient was planned for right total hip replacement, followed by left total hip replacement at a later stage
- As part of the pre-operative skeletal assessment, DXA scan of the lumbar spine and hip were done
- DXA scan results showed osteoporosis
Intraoperative
- Intraoperatively, the bone was noted to be fragile
- Extra care had to be taken to avoid intraoperative iatrogenic fracture
- Right total hip replacement was done successfully
Pharmacological
- For post-operative bone health optimisation and treatment of underlying osteoporosis, subcutaneous Romosozumab 210 mg monthly was started after the surgery
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Follow Up
- After completing Romosozumab for 1 year, the DXA scan was repeated
- Patient was continued on subcutaneous Denosumab 60 mg 6-monthly
- Subsequently planned for left total hip replacement
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Results- DXA Scan
Pre-operative DXA scan
DXA scan following 1 year on Romosozumab
Pre-operative DXA scan"
DXA scan following 1 year on Romosozumab
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Summary
- 1st DXA: Prior to right THR
- Patient was started on Romosozumab after right THR
- 2nd DXA: After 1 year on Romosozumab
- Lumbar spine BMD changes: [(0.843-0.771)/0.771] X 100% = 9.3%
- Total Hip BMD changes: [(0.820-0.809)/0.809] X 100% = 1.4%
- Currently on subcutaneous Denosumab 60mg 6-monthly
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Estimated Fracture Risk Reduction Associated With BMD Improvement1
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References
1. Bouxsein ML, Eastell R, Lui LY, et al.; FNIH Bone Quality Project. Change in Bone Density and Reduction in Fracture Risk: A Meta-Regression of Published Trials. J Bone Miner Res. 2019 Apr;34(4):632-642.
Abbreviations
BMD, bone mineral density; DXA, dual-energy X-ray absorptiometry; L1, first lumbar vertebrae; L2, second lumbar vertebrae; L3, third lumbar vertebrae; L4, fourth lumbar vertebrae; THR, total hip replacement
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Important Safety Information:Osteoporosis Case BinderThis curated collection of patient case studies aims to provide healthcare practitioners in the area of bone health, with a comprehensive understanding of risk-based treatment approach in the long-term management of patients living with osteoporosis.The patient cases were contributed by bone health experts from respective clinical setting, incorporating evidence-based discussions, guidelines and clinical considerations in the individualised treatment sequencing plans of different real-world scenarios..Please review full product information before prescribingFor Healthcare Professionals Only.Please refer to full prescribing information prior to administrationFor information on Amgen products or to report an adverse event involving an Amgen product, please contact Medical Information at 1800 818 227 or medinfo.JAPAC@amgen.comSC-MAL-CP-00128-0425Endorsed By:
