Case report: A 29-year-old female with a 17-year history of severe enduring anorexia nervosa attended our unit. Osteoporosis was diagnosed aged 24 and she had developed a left calcaneal fracture after minimal trauma 3 weeks prior to presentation. Her bone mineral density at this time confirmed the presence of osteoporosis at the lumbar spine and total hip (T-score −3.3 and −2.9 respectively) and her body mass index was low at 15.1 kg/m2. She declined therapy previously with oestrogen and bisphosphonate therapy and was not keen to undertake daily injections. A decision was made to commence therapy with Denosumab 60 mg by s.c. injection every 6 months with monitoring of serum calcium and co-administration of calcium and vitamin D. A further measurement of bone mineral density was made 2 months after completing 3 years of therapy with Denosumab. During the period of treatment the patient did not experience any adverse effects related to the treatment. There was no evidence of hypocalcaemia nor were there further fractures. Bone mineral density increased substantially at the lumbar spine The measurement at the left femoral neck showed a reduction of −5.7% from its pre-treatment value (Table 1).
|Scan date||Age||BMD (g/cm2)||T-score||BMD change|
|Vs baseline||Vs previous|
|Lumbar spine: L1L4|
|Left total hip|
Conclusion: Denosumab is a potentially efficacious treatment for osteoporosis in anorexia nervosa.