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Case contributed by Dr. Chan Chee Ken, Consultant Orthopaedic and Trauma Surgeon, Mahkota Medical Centre, Malaysia
Patient Information
Age: 75 years (Menopause at age 45 years old)
Sex: Female
Underlying diseases:
- Hypertension on Perindopril Arginine/Amlodipine 5 mg/5 mg OD
- Diabetes mellitus on Linagliptin 5 mg OD, Metformin XR 750 mg
- Previous hysterectomy for uterine myoma at age 45 years old
- Gastritis
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History
Presenting complaint
Patient presented with low back pain.
- Unable to sit and stand for long time due to the pain
- Started to have low back pain after gardening work
- The pain was not much improved by oral medication and subcutaneous steroid injection
- Duration: 6 months
Past medical history
- No history of trauma or fall
- Did not consume any traditional chinese medicine or exogenous steroid previously
- No family history of inflammatory joint diseases
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Physical examination
- Clinically tender over the lumbar region especially the lower lumbar region
- No neurological deficits
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Investigation
Lumbar X-ray, MRI Lumbar and blood tests
- Lumbar X-ray: Reduced height of L2, L4 and L5 vertebrae
- MRI: Biconcave compression fractures at L2, L4 and L5 vertebrae
- Blood test with tumour marker: Normal
- Interpretation: Osteoporotic fracture of L2, L4 and L5
Bone Mineral Densitometry (BMD) T-scores
- Lumbar Spine: -4.0
- Hip: -1.6
- Interpretation: Severe osteoporosis
Pre-operative DXA scan (Height:144cm, Weight: 46kg)
AP Spine Results
10-year Probability of Fracture
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Treatment
Pharmacological
- Calcium carbonate 600mg OD
- Vitamin D 500mg OD
Non-pharmacological
- She was treated with lumbar corset.
- Due to fragility fractures, DXA scan of the lumbar spine and hip were done.
- Blood test was performed as well and was normal.
- DXA scan results showed severe osteoporosis.
Referral
She was referred to an endocrinologist for starting of subcutaneous Romosozumab 210 mg monthly.
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Follow-up
Disease progression
After 3 months of subcutaneous Romosozumab, her back pain improved* and she was advised to wear lumbar corset whenever necessary.
* Romosozumab is not indicated for treatment of back pain.
Trend of investigation parameters
Patient was continued on subcutaneous romosozumab for full course of 1 year.
After completing Romosozumab for 1 year, DXA scan was repeated.
DXA scan following 1 year on Romosozumab
AP Spine Results
10-year Probability of Fracture
She was continued on subcutaneous Denosumab 60 mg every 6 months.
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Summary
- Patient presented with low back pain, and investigations revealed osteoporotic fractures of L2, L4 and L5.
- Bone mineral densitometry results revealed severe osteoporosis.
- Patient was treated with lumbar corset and started subcutaneous Romosozumab 210 mg monthly.
- After 3 months of subcutaneous Romosozumab, her back pain improved and she was advised to wear lumbar corset whenever necessary.
- Patient was continued on subcutaneous Romosozumab for full course of 1 year with the below BMD changes:
- Lumbar spine BMD changes: [(0.774-0.602)/0.602] X100% =28.6%
- Total hip BMD changes: [(0.920-0.790)/0.790] X100% =16.5%
- Patient was subsequently continued on subcutaneous Denosumab 60 mg every 6 months.
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Estimated Fracture Risk Reduction Associated with BMD Improvement1
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Reference
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; MRI, magnetic resonance imaging; OD, once daily; XR, extended release
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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-00137-Aug2025Endorsed By:
