The Rheumatologist
COVID-19 NewsACR Convergence
  • Connect with us:
  • Facebook
  • Twitter
  • LinkedIn
  • YouTube
  • Feed
  • Home
  • Conditions
    • Rheumatoid Arthritis
    • SLE (Lupus)
    • Crystal Arthritis
      • Gout Resource Center
    • Spondyloarthritis
    • Osteoarthritis
    • Soft Tissue Pain
    • Scleroderma
    • Vasculitis
    • Systemic Inflammatory Syndromes
    • Guidelines
  • Resource Centers
    • Axial Spondyloarthritis Resource Center
    • Gout Resource Center
    • Psoriatic Arthritis Resource Center
    • Rheumatoid Arthritis Resource Center
    • Systemic Lupus Erythematosus Resource Center
  • Drug Updates
    • Biologics & Biosimilars
    • DMARDs & Immunosuppressives
    • Topical Drugs
    • Analgesics
    • Safety
    • Pharma Co. News
  • Professional Topics
    • Ethics
    • Legal
    • Legislation & Advocacy
    • Career Development
      • Certification
      • Education & Training
    • Awards
    • Profiles
    • President’s Perspective
    • Rheuminations
    • Interprofessional Perspective
  • Practice Management
    • Billing/Coding
    • Quality Assurance/Improvement
    • Workforce
    • Facility
    • Patient Perspective
    • Electronic Health Records
    • Apps
    • Information Technology
    • From the College
    • Multimedia
      • Audio
      • Video
  • Resources
    • Issue Archives
    • ACR Convergence
      • Gout Resource Center
      • Axial Spondyloarthritis Resource Center
      • Psoriatic Arthritis
      • Abstracts
      • Meeting Reports
      • ACR Convergence Home
    • American College of Rheumatology
    • ACR ExamRheum
    • Research Reviews
    • ACR Journals
      • Arthritis & Rheumatology
      • Arthritis Care & Research
      • ACR Open Rheumatology
    • Rheumatology Image Library
    • Treatment Guidelines
    • Rheumatology Research Foundation
    • Events
  • About Us
    • Mission/Vision
    • Meet the Authors
    • Meet the Editors
    • Contribute to The Rheumatologist
    • Subscription
    • Contact
  • Advertise
  • Search
You are here: Home / Articles / Challenging Cases in Osteoporosis: Tips from an Expert

Challenging Cases in Osteoporosis: Tips from an Expert

June 18, 2022 • By Samantha C. Shapiro, MD

  • Tweet
  • Email
Print-Friendly Version / Save PDF

Romosozumab is a monoclonal antibody that inhibits sclerostin, “with a dual effect of increasing bone formation and decreasing bone resorption,”7 Dr. Saag said. “Romosozumab is an inhibitor of bone formation and, thus, highly anabolic. When compared with teriparatide and alendronate, it’s really the most impressive in terms of increasing BMD.”8

You Might Also Like
  • Amgen, UCB Say Osteoporosis Drug Meets Main Goal in Late-Stage Trial
  • Novel Bone Drug Promising in Postmenopausal Osteoporosis
  • At Least 1 Year on Bisphosphonates Needed for Fracture Prevention
Explore This Issue
July 2022
Also By This Author
  • Remission Definitions in RA: Common Questions & Implications for Clinical Practice

When compared with alendronate, romosozumab also significantly reduced the risk of new vertebral fracture at 12 and 24 months.9

ad goes here:advert-1
ADVERTISEMENT
SCROLL TO CONTINUE

After receiving romosozumab, the patient was switched to denosumab. Dr. Saag said, “After we use an osteoanabolic drug, we should follow it with an antiresorptive. The pivotal study by Cosman et al. demonstrated the importance of this [approach].”7

‘Osteoporotic risk goes up after two years off therapy, & just how much depends on what bisphosphonate [the patient] took before. Some bisphosphonates are stickier to bone than others.’ —Dr. Saag

Case 3

A 48-year-old man with ulcerative colitis and spondyloarthritis on adalimumab, CKD with a GFR of 26, vertebral compression fracture on imaging and T-scores in the osteopenic range was referred for management. Although very low in the past, the patient’s 25-hydroxy vitamin D levels had normalized with supplementation. Calcium, phosphorous and 1,25-dihydroxyvitamin D levels were also normal. Parathyroid hormone and bone-specific alkaline phosphatase were slightly elevated. In the past, he was treated with several months of high-dose glucocorticoids.

Given the complexity of the case, Dr. Saag walked us through his thought process. The differential diagnosis included glucocorticoid-induced osteoporosis, metabolic bone disease due to CKD and vitamin D malabsorption with possible secondary hyperparathyroidism.

When it came to therapy, Dr. Saag said, “I wasn’t sure any of our drugs were good options, or that he even had osteoporosis. About 15% of men have evidence of vertebral compression fractures on imaging prior to the age of 50—so this may not have been an osteoporotic fracture after all. And for him, I was particularly worried about adynamic bone disease, which is a contraindication to antiresorptives.”

ad goes here:advert-3
ADVERTISEMENT
SCROLL TO CONTINUE

Adynamic bone disease is a type of renal osteodystrophy characterized by low or absent bone turnover in the context of a marked reduction in both osteoblast and osteoclast numbers. Bone biopsy remains the gold standard for diagnosis.

For this patient, Dr. Saag opted not to treat for osteoporosis. Instead, he recommended maintaining adequate vitamin D levels, monitoring for hyperparathyroidism and consideration of a bone biopsy.

Summary

The treatment of osteoporosis includes more than just bisphosphonates these days, and that’s a good thing. But careful consideration of a patient’s comorbidities—as well as the risks and benefits of continuing and discontinuing therapy—are paramount when it comes to protecting our patients from fractures.=

ad goes here:advert-2
ADVERTISEMENT
SCROLL TO CONTINUE

Pages: 1 2 3 4 | Single Page

Filed Under: Conditions, Education & Training, Meeting Reports Tagged With: ACR Education Exchange, bisphosphonates, denosumab, education and training, Osteoporosis, romosozumabIssue: July 2022

You Might Also Like:
  • Amgen, UCB Say Osteoporosis Drug Meets Main Goal in Late-Stage Trial
  • Novel Bone Drug Promising in Postmenopausal Osteoporosis
  • At Least 1 Year on Bisphosphonates Needed for Fracture Prevention
  • A Balancing Act: Tips to Ensure Optimal Screening & Treatment for Osteoporosis

Rheumatology Research Foundation

The Foundation is the largest private funding source for rheumatology research and training in the U.S.

Learn more »

Meeting Abstracts

Browse and search abstracts from the ACR Convergence and ACR/ARP Annual Meetings going back to 2012.

Visit the Abstracts site »

American College of Rheumatology

Visit the official website for the American College of Rheumatology.

Visit the ACR »

The Rheumatologist newsmagazine reports on issues and trends in the management and treatment of rheumatic diseases. The Rheumatologist reaches 11,500 rheumatologists, internists, orthopedic surgeons, nurse practitioners, physician assistants, nurses, and other healthcare professionals who practice, research, or teach in the field of rheumatology.

About Us / Contact Us / Advertise / Privacy Policy / Terms of Use / Cookie Preferences

  • Connect with us:
  • Facebook
  • Twitter
  • LinkedIn
  • YouTube
  • Feed

Copyright © 2006–2023 American College of Rheumatology. All rights reserved.

ISSN 1931-3268 (print)
ISSN 1931-3209 (online)