Osteoporosis Clinical Case

Osteoporosis Clinical Case

Mahbube Ebrahimpur MD
TUMS, Shariati Hospital
November16, 2018

• A healthy 70-year-old woman returns for followup of generalized osteoporosis.
• She has been on ALN, 70 mg by mouth weekly with excellent compliance for 4 years as well as adequate calcium and vitamin D.
•  A repeat DXA shows stable values at all sites with T-scores of

   spine : –2.8 (8% increase since baseline)

   FN: –3.0

   TH: –2.8 (4.5% increase since baseline).

• After sustaining a wrist fracture at age 65, she has done well. Two months after seeing you, she trips over a branch while hiking in the woods, fracturing her left humerus.
•  Laboratory work-up reveals normal CBC, Ca, Phos, creatinine, 25OHD, serum and urine protein electrophoresis, alk phos, and urinary calcium excretion.
•  A fasting serum CTX comes back in the lowest 25th percentile for premenopausal women.
• What is the most appropriate management?

A. Stop ALN and begin teriparatide.

B. Stop ALN and begin ZA.

C. Stop ALN and begin DMA.B

D. Continue ALN for now.