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Case contributed by Clin Assoc Prof Reuben Soh Chee Cheong, Senior Consultant in Orthopaedic Surgery, Singapore General Hospital

Patient Information

Age: 53 years

Sex: Female

  • History

    Presenting complaint

    • Right leg discomfort and claudication
    • Diagnosed with progressive kyphoscoliosis
    Presenting complaint
  • Investigation

    Preoperative BMD

    Preoperative BMD

    Preoperative MRI

    • Multilevel stenosis at the neural foramina, L34 and L45
    Preoperative MRI

    Preoperative CT scan

    • The Hounsfield unit is 141, which is indicative of osteoporosis.
    • The CT also demonstrated the severity of the scoliosis.
    Preoperative CT scan
  • Treatment

    Pharmacological

    • Patient was started on Romosozumab in January 2024 for three months
    • Romosozumab was considered as patient preferred a monthly injection

    Surgical

    • Patient was planned for a 2-stage surgery
      • Stage 1 : Multiple interbody fusion from L3 to S1, Halo gravity traction (20/3/2024)
      • Stage 2 : Posterior releases and instrumentation (3/4/2024)
  • Follow-up

    Postoperative findings

    • Post-stage-1 findings:
    Postoperative finding
    • 2-year follow-up postoperatively:
    2-year follow-up postoperatively:
    • Postoperative CT scan demonstrated successful fusion
    Postoperative CT scan demonstrated successful fusion
    • Postoperative BMD
      • Increased from -2.7 to -2.4
    Postoperative BMD
    • Patient was continued on romosozumab for up to 1 year after treatment initiation (Dec 2024) and was maintained on denosumab lifelong.
  • Summary
    • Patient presented with right leg discomfort and claudication, and was diagnosed with progressive kyphoscoliosis.
    • Before surgery, patient had a T-score of -2.7, and imaging scans revealed multilevel stenosis at the neural foramina, L34 and L45.
    • CT scan revealed a Hounsfield unit of 141, which is indicative of osteoporosis. The CT scan also demonstrated the severity of the scoliosis.
    • Following that, patient was started on romosozumab (Jan 2024) for 3 months prior to surgery.
    • Patient underwent a 2-stage surgery:
      • Stage 1 : Multiple interbody fusion from L3 to S1, Halo gravity traction (20/3/2024)
      • Stage 2 : Posterior releases and instrumentation (3/4/2024)
    • During follow-ups after surgery, imaging scans revealed successful fusion and an improvement in BMD.
    • Patient was continued on romosozumab for up to 1 year after treatment initiation (Dec 2024) and was maintained on denosumab lifelong.
  • Abbreviations

    BMD, bone mineral density; CT, computed tomography; MRI, magnetic resonance imaging

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  • Important Safety Information:
    Osteoporosis Case Binder
    This curated collection of patient case studies aims to provide healthcare practitioners in the area of bone health, with a comprehensive understanding of risk-based treatment approach in the long-term management of patients living with osteoporosis.
    The patient cases were contributed by bone health experts from respective clinical setting, incorporating evidence-based discussions, guidelines and clinical considerations in the individualised treatment sequencing plans of different real-world scenarios..
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    SC-SGP-AMG162-00142-Apr2026