The effect of teriparatide for the treatment of multiple spontaneous clinical vertebral fractures after discontinuation of denosumab in a female patient with rheumatoid arthritis: A case report

Yu Mori, Takuya Izumiyama, Naoko Mori, Toshimi Aizawa

Research output: Contribution to journalArticlepeer-review

Abstract

Discontinuation of denosumab is associated with the risk of rebound in bone turnover and rebound-associated spontaneous clinical vertebral fractures. This case report presents an 86-year-old woman with rheumatoid arthritis who experienced rebound-associated spontaneous clinical vertebral fractures at 9 months after denosumab discontinuation. Following 5-year bisphosphonate treatment, the patient had 9 injections of 60-mg denosumab every 6 months. Because of tooth extraction, denosumab treatment was discontinued, and raloxifene was administered. At 9 months after the last denosumab injection, the patient experienced severe low back pain. Magnetic resonance imaging (MRI) and radiograph demonstrated clinical fracture at the fourth lumbar vertebra. MRI performed at 3 months after first fracture showed two additional fractures at the second and third lumbar vertebrae. Teriparatide was administered for management of rebound-associated spontaneous clinical, multiple vertebral fractures. Teriparatide was effective for accelerating the fracture healing and suppressing the occurrence of new fractures. However, 2-year treatment of teriparatide did not have suppressive effect of rebound in bone turnover and general bone loss. This case suggested that teriparatide was effective for suppression of new rebound-associated spontaneous clinical vertebral fractures, but not effective in prevention of general bone loss after denosumab discontinuation.

Original languageEnglish
Pages (from-to)57-61
Number of pages5
JournalTohoku Journal of Experimental Medicine
Volume254
Issue number1
DOIs
Publication statusPublished - 2021

Keywords

  • Denosumab discontinuation
  • Osteoporosis
  • Rebound effect
  • Spontaneous multiple vertebral fracturteriparatide

ASJC Scopus subject areas

  • Biochemistry, Genetics and Molecular Biology(all)

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