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Case contributed by Dr Gamaliel Tan Yu-Heng, Orthopaedic Spine Surgeon, Mount Elizabeth Hospital, Singapore.
Patient Information
Age: 84 years
Sex: Female
Underlying diseases:
- Dementia
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History
Presenting complaint
- Low back pain after fall at home
- Duration: 1 week
- Patient uses walking frame at home, assisted by helper
- She sat down hard on toilet seat and complained of lower back pain.
- Low back pain after fall at home
-
Physical examination
- Physical examination revealed a tender lower back
- Patient was found to have a compression fracture at L1 on X-ray.
-
Investigation
BMD on August 2024
- Hip T-score: -3.1
- Spine T-score: -1.7
Left Hip BMD Before Romosozumab Treatment
Region BMD
(g/cm3)T-score Left Neck 0.501 - 2.9 Total 0.557 - 3.1 Spine BMD Before Romosozumab Treatment
Region BMD
(g/cm3)T-score L2 0.799 - 1.5 L3 0.840 - 1.5 L4 0.812 - 1.8 Total 0.817 - 1.7 -
Treatment
Non-pharmacological
- Calcium
- Vitamin D
Pharmacological
- Romosozumab was initiated for 12 months, until October 2025
- Patient has a lumbar spine fracture and is at high risk of further falls due to her dementia and frailty. Given her severe BMD score, Romosozumab was chosen as it provides the fastest way to increase bone density.
-
Follow-up
Disease progression
- There is a slight improvement in hip T-score; while there more improvement in spine T-score.
- BMD on October 2025, 1 year after romosozumab initiation:
- Hip T-score: -3.0
- Spine T-score: -1.2
Left Hip BMD After 1 Year Romosozumab Treatment
Region BMD
(g/cm3)T-score Left Neck 0.522 - 2.7 Total 0.568 - 3.0 Spine BMD After 1 Year Romosozumab Treatment
Region BMD
(g/cm3)T-score L2 0.872 - 0.9 L3 0.899 - 1.1 L4 0.875 - 1.3 Total 0.882 - 1.2 -
Summary
- Patient complained of low back pain after a fall at home, and was found to have a compression fracture at L1
- The BMD values on presentation were:
- Hip T-score: -3.1
- Spine T-score: -1.7
- Patient has a lumbar spine fracture and is at high risk of further falls due to her dementia and frailty. Given her severe BMD score, Romosozumab was initiated for 1 year as it provides the fastest way to increase bone density.
- After 1 year on romosozumab, there was a slight improvement in hip T-score; while there more improvement in spine T-score.
- Hip T-score: -3.0
- Spine T-score: -1.2
- Changes in BMD after completing 1 year of Romosozumab
- Total hip BMD changes: [(0.568 – 0.557)/0.557 X 100% = 1.97%
- Lumbar spine BMD changes: [(0.882 – 0.817)/0.817 X 100% = 7.95%
-
Estimated Fracture Risk Reduction Associated with BMD Improvement
Estimated Fracture Risk Reduction1
-
References
1. Bouxsein ML, Eastell R, Lui LY, et al; FNIH Bone Quality Project. Change in Bone Density and Reduction in Fracture Risk: A Meta-Regression of Published Trials. J Bone Miner Res. 2019 Apr;34(4):632-642.
Abbreviations
BMD, bone mineral density
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Important Safety Information:Osteoporosis Case BinderThis 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..Please review full product information before prescribingFor Healthcare Professionals Only.Please refer to full prescribing information prior to administrationFor information on Amgen products or to report an adverse event involving an Amgen product, please contact Medical Information at 800-616-7094 or medinfo.JAPAC@amgen.comSC-SGP-AMG785-00048-May2026