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Case contributed by Prof. Datuk Dr. Sabarul Afian Mokhtar, Senior Consultant Orthopaedic Surgeon (Spine Surgery)
Hospital Canselor Tuanku Muhriz Universiti Kebangsaan Malaysia
Patient information
Age: 84 years
Sex: Female
Underlying Disease:
- Treatment-naïve
- Housewife
- History of cardiovascular event: Ischaemic heart disease (Stent inserted)
- No family history of osteoporosis
- Dyslipidaemia and hypertension
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History
Presenting complaint
- History of fall: Sustained fracture of maxillary bone
- Patient was referred by the oral and maxillofacial surgery (OMFS) team for chronic lower back pain: Old vertebral fracture at L1
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Physical Examination
Weight: 53 kg
Height: 149 cm
BMI: 23.8 kg/m2
Specific
- No features of neurological deficit
- No features of Cushing syndrome
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Investigation
Blood investigations
- All blood investigations were normal
- Vitamin D (25-OH): 49.0 nmol/L
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Fall History
Multiple fragility fractures
- Both wrists – on different occasions
- Left proximal humerus
- Left patella (undisplaced)
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Treatment
Pharmacological
- Patient was started on Teriparatide therapy as she had multiple untreated fragility fractures and underlying cardiovascular disease with stent inserted previously
- Following completion of Teriparatide therapy, she was transitioned to Denosumab therapy
6-monthly
Spine X-ray upon admission
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Follow Up
Upon completion of Teriparatide therapy for maximum duration of 2 years, patient was transitioned to Denosumab therapy 6-monthly
Long-term treatment plan for patient:
- Continue Denosumab 6-monthly
- Continue Vitamin D
- Encourage exercise
- DXA scan every 2 years
Previous Left Wrist X-ray
Previous Shoulder X-ray
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Results- DXA Scan
Spine
Hip
-
Summary
Patient presented with an old vertebral fracture at L1
1st DXA scan done upon admission
Patient was started on Teriparatide therapy
2nd DXA scan done after 8 months of Teriparatide therapy- Spine T-score: [(0.772 – 0.748)/0.748] X 100% = 3.2%
- Hip T-score: [(0.513 – 0.535)/0.535] X 100% = -4.2%
3rd DXA scan done after 2 years of Denosumab therapy
- Spine T-score: [(0.863 – 0.772)/0.772] X 100% = 11.8%
- Hip T-score: [(0.549 – 0.513)/0.513] X 100% = 7.0%
Treatment goal for this patient is to prevent subsequent fracture(s) since osteoporosis is a chronic disease requiring long-term treatment.
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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
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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:
