Endocrine Abstracts

A 77 year-old lady with a past medical history significant for endometrial cancer previously treated with chemotherapy and radiotherapy attended metabolic bone clinic for management of severe osteoporosis of the lumbar spine with previous fragility fractures. She had fallen from standing height within the last year and sustained compression fractures of the lumbar spine at L1 and L4. A DEXA conducted post-fall revealed mean T-scores of -3.6 for the lumbar spine, - 2.1 for the total hips and -2.6 for the femoral necks. Routine blood tests were largely unremarkable- bone profile was in normal range and the patient was vitamin D replete. P1 NP was noted to be slightly raised at 61.3 ug/l, potentially reflecting recent fracture. Risk factors for low bone mineral density identified were being postmenopausal, history of endometrial cancer treated with chemotherapy, and previous fragility fractures. Calculations using FRAX indicated ten-year fracture probabilities of 24% for major osteoporotic and 8.1% for hip fractures, and with NOGG guidelines thus recommending treatment. Treatment options considered included bisphosphonates, denosumab, abaloparitide and romosozumab. Abaloparitide was contraindicated due to previous radiotherapy exposure. The patient met the NOGG criteria for starting romosozumab (severe osteoporosis with fragility fractures within the past 24 months with T score <-3.5). In counselling the patient on this medication, a possible increase in cardiovascular risk was discussed (~1% increased risk for heart attack and stroke). The patient’s QRISK3 score was calculated, which indicated a risk of heart attack or stroke similar to what would otherwise be expected for her age (absolute 10-year risk of heart attack or stroke 19.7%, relative risk 1.0). She was encouraged to maintain good calcium intake, including regular calcium and vitamin D supplementation, as well as good dental hygiene, with a plan to commence anti-resorptive therapy on completion of the one-year course of romosozumab. The patient was referred to our specialist nursing team for commencement of romosozumab, with a plan to review her again in clinic in 4 months with repeat blood and urine tests for bone turnover markers.