Endocrine Abstracts

A 72 year old lady was referred after recurrence of fragility fractures, despite being on bisphosphonate therapy for 10 years. She had 2 low-impact falls in 2020 and 2021, which resulted in hip and right distal femur fractures respectively. She had been compliant on alendronic acid 70mg once weekly since 2012, when she was diagnosed with osteoporosis at the age of 62, after sustaining 2 fragility fractures of the distal radius and elbow after separate low-impact falls. DXA scan at the time showed a left femur total T score of -3.5 On review, she confirmed adherence to alendronic acid. She did not feel she was losing height. Her appetite was unremarkable and she did not have any pain or constitutional symptoms. She was an ex-smoker with a 50 pack year smoking history. She drank alcohol occasionally. She had 2 children and did not report any menstrual issues pre-menopause. Her menopause was at the age of 48. There was no parental history of hip fracture or osteoporosis. She was mobile with a frame Her past medical history included polio as a child, COPD (diagnosed in 2016), and hypertension. She had been on an inhaled steroid since her COPD diagnosis and has had at least one 5-day course of oral prednisolone for COPD exacerbation per year On examination, her weight was 70 kg, height 1.67 m, and BMI 25 kg/m². There was no kyphosis or vertebral tenderness on palpation Baseline bloods showed a normal full blood count, renal, liver and thyroid function. Bone profile was normal and she was vitamin D replete. ALP was mildly raised at 134. Coeliac screen was negative. There was no paraprotein on myeloma screen. Bone turnover marker, CTX was within normal limits A repeat DXA scan showed a left hip bone density in the osteoporotic range with a T score of -3.5. Vertebral fracture assessment (VFA) from L5 to T4 did not reveal any definite fractures A diagnosis of bisphosphonate treatment failure was therefore made She was referred to the metabolic bone MDT for initiation of second line osteoporosis medication Potential drugs that would be considered include denosumab and teriparatide.