This spinal fractures patient had unusual rapid rise in BMD by bisphosphonates: a report

Dr Hidefumi Koiwai at Koiwai Orthopedic Clinic, Mikageshinden, Komoro, Japan and colleagues have reported a rare case of Unexpected rapid rise in bone mineral density by bisphosphonates in a case of spinal fractures. The case has appeared in the Journal of Medical Case Reports.

It is strange that after 3 years of treatment with the bisphosphonate alendronate, the lumbar bone mineral density and bilateral hip bone mineral density of patient markedly increased by 61.9% and 32.5%, respectively. The authors concluded that the patient’s multiple fractures had caused a decrease in bone mineral density, which naturally improved with fracture healing to enhance the increase in bone mineral density with bisphosphonate treatment.

Osteoporosis is a serious disease that causes bone fragility fractures and increases mortality. Bisphosphonates are the first-line drugs for osteoporosis. However, the gains in bone mineral density by use of bisphosphonates alone are limited.

The patient was a 59-year-old Japanese woman 49 kg in weight and 153.2 cm in height. Her chief complaint upon presentation was severe back pain. She reported having a total of five episodes of strong acute back pain in the previous year.

At the first visit, her L-BMD was 0.572 g/cm2 (− 4.5 standard deviation [SD]), and her H-BMD was 0.671 g/cm2 (− 2.2 SD). Spinal radiographs showed five vertebral compression fractures. Bone turnover markers (BTMs) were highly increased. Bone scintigraphy revealed high accumulation at one lumbar vertebra and one thoracic vertebra, with diffuse mild uptake throughout the entire spine.

She was diagnosed with the OP in accordance with the revised criteria established by the Japanese Society for Bone and Mineral Research. Because daily TPTD was not possible, owing to her living abroad, ALN 35 mg/week was prescribed until her planned return. One month later, her back pain was relieved, and she returned home. At 4 months of ALN, L-bone mineral density and H-bone mineral density were greatly increased by 29.5% and 18.3%, respectively. Hence, ALN treatment was continued.