Biological therapy for osteoporosis - solving clinical problems - a case report

Introduction. Elucidation of the pathogenetic mechanisms of osteoporosis has led to the development of new and effective drugs from the group of biological agents. Case report. In April 2018, a 64-year-old female patient was presented to the hospital due to low back pain. She was diagnosed with postmenopausal osteoporosis based on bone density scan score and a compression fracture of the L1 vertebral body revealed by X-ray. She was treated with a weekly bisphosphonate and supplementation with vitamin D and calcium. After one year, monthly bisphosphonate was introduced in therapy because of an inadequate response. In April 2020, the patient was treated for COVID-19 according to protocol, and during the treatment, bisphosphonate therapy was discontinued. After five months, she suffered a fracture of her left forearm. Due to the persistence of low mineral bone density, which was complicated by a new fracture, denosumab 60 mg subcutaneously once every six months was initiated with additional vitamin D and calcium supplementation. At six months follow-up, an increase in mineral bone density was verified, and after 12 months, the dual-energy x-ray absorptiometry score was within the osteopenia range. Laboratory findings showed a decrease in bone turnover markers. Conclusion. One-year administration of denosumab led to a significant increase in bone mineral density measured at the lumbar spine and neck of the femur, as well as changes in the levels of biochemical markers of bone synthesis and resorption, and reduced the risk of new fractures.