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Case contributed by Dato' Dr Siva Kumar Ariaretnam, Consultant Orthopaedic Surgeon, Subang Jaya Medical Centre, Malaysia
Patient information
Age: 48 years
Sex: Female
Underlying Disease:
- Gynaecological disease: Total abdominal hysterectomy and bilateral salpingo-oophorectomy (TAHBSO) was done
- On and off joints pain: On Calcium and Vitamin D supplementation
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History
Presenting complaint
- BMD measurement was performed on 27th February 2021 prior to undergoing TAHBSO.
- The BMD T-scores were -1.8 for the lumbar spine and total hip.
- One year after the TAHBSO, the BMD measurement was repeated on 25th April 2022.
- The BMD T-scores had deteriorated to -3.2 for the lumbar spine and -1.7 for the total hip.
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Physical Examination
General (25th April 2022)
Weight: 59 kg
Height: 170 cm
BMI: 20.4 kg/m2
Specific
- General weakness and back pain
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Investigation
Blood investigations
- All blood investigations were normal
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Treatment
Pharmacological
- Patient continued the calcium and vitamin D supplementation
- Following the TAHBSO, the patient was found to be an unsuitable candidate for hormone replacement therapy
- Patient was started on Romosozumab therapy on the 25th April 2022
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Follow Up
- Upon completing one year of Romosozumab therapy, a BMD measurement was repeated on 29th May 2023, showing an improvement in T-scores to -2.2 at the lumbar spine and -1.3 at the total hip.
- The patient was then transitioned to Alendronate.
- Additionally, the bone and joint pain she had experienced for several years appeared to have resolved.
- Functionally, the patient was able to start exercising in the gym again.
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Results- DXA Scan
Baseline
After 1 year of Romosozumab therapy
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Summary
The patient was under follow-up for intermittent joint pain*
A BMD measurement was performed on 27th February 2021, prior to undergoing TAHBSO.
The patient was started on calcium and vitamin D supplementation. Another BMD measurement was taken on 25th April 2022, one year after the TAHBSO, and Romosozumab therapy was initiated.
A further BMD measurement was done after completing one year of Romosozumab therapy, on
29th May 2023.
BMD results improved, and the patient’s bone and joint pain resolved*- Spine BMD change: [(0.754 - 0.639) / 0.639] x 100% = 18%
- Hip BMD change: [(0.699 - 0.653) / 0.653] x 100% = 7%
*Kindly note that romosozumab is not indicated for pain relief of the bone or joints. Kindly refer to the local prescribing information for the approved indication of romosozumab.
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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; BMD, bone mineral density; TAHBSO, total abdominal hysterectomy with bilateral salpingo-oophorectomy
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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:
