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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: 62 years 

Sex: Female

Relevant patient demographics: Menopause at 55

  • History

    Presenting complaint

    • On follow up for osteoporotic vertebral compression fracture L1
    • Found to have spinal stenosis L5/S1 with foraminal stenosis L5/S1
    Presenting complaint
  • Investigation

    Preoperative BMD

    Preoperative BMD

    Preoperative MRI

    • Foraminal stenosis of L5/S1
    Preoperative MRI
  • Treatment

    Surgical

    • Patient underwent surgery to correct for her stenosis

    Pharmacological

    • Patient was started on Romosozumab for 1 year, immediately after surgery
    • After completion of romosozumab, patient was maintained on 6-monthly denosumab
  • Follow Up

    Postoperative findings

    • Imaging showed successful union of L5/S1
    Postoperative findings

    BMD after 1-year romosozumab

    BMD after 1-year romosozumab
  • Summary
    • Patient was found to have spinal stenosis L5/S1 with foraminal stenosis L5/S1 during a follow up for osteoporotic vertebral compression fracture L1
    • Before surgery, patient had a T-score of -2.6, and imaging scans revealed foraminal stenosis of L5/S1
    • Patient underwent surgery to correct for her stenosis. She was immediately started on romosozumab post-surgery.
    • During follow-ups after surgery, imaging scans revealed
      • successful union of L5/S1 post-surgery
      • an improvement in BMD after taking romosozumab for 1 year.
    • Patient was maintained on 6-monthly denosumab.
  • Abbreviations

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

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    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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