Reactions 1680, p218 - 2 Dec 2017 Osteoporosis and multiple vertebral fractures: case report A 71-year-old woman developed osteoporosis and multiple vertebral fractures during treatment with meprednisone [route not stated; not all times to reactions onsets and outcomes not stated]. The woman, who was diagnosed with lupus nephropathy was started on meprednisone 40 mg/day. During the first year of meprednisone therapy, she experienced multiple vertebral fractures. Considering the severity of the woman’s osteoporosis and a glomerular filtration rate of 58 mL/min, she received a single dose of zoledronic acid. However, she continued to experience vertebral fractures in spite of corrective treatment. She was then referred for a bone and mineral metabolism evaluation. She was receiving meprednisone 4 mg/day and omeprazole at the time of the bone and mineral metabolism assessment. Simple radiographs of the spine demonstrated multiple vertebral fractures. A bone mineral density assessment was performed using dual-energy X-ray absorptiometry. The findings of this assessment were total right femur (TRF): 0.710 g/cm , T-score: –2.4; total left femur 2 2 (TLF): 0.706 g/cm , T-score: –2.5 and LS (L2–L4): 0.772 g/cm , T-score: –3.6. The laboratory parameters of mineral metabolism were within the reference ranges. Subsequently, she was started on subcutaneous teriparatide [Forteo] 20 µg/day for her meprednisone-induced osteoporosis, and her meprednisone dose was 2 mg/day at that time. Three months following the initiation of teriparatide treatment, laboratory investigations demonstrated an elevated uric acid level of 7.6 mg/dL. Thereafter, the frequency of teriparatide administration was reduced to three times weekly. Four months later, her uric acid level normalised. Seven months following the initiation of teriparatide therapy, meprednisone was discontinued. Nine months after teriparatide was started, a bone mineral density reassessment was performed, which revealed a 5% reduction in LS with stable TRF and TLF values. She reported injecting teriparatide at night in the abdominal region. She was then advised to administer the teriparatide injection in the morning following breakfast. After the change in the administration time and with three weekly doses of teriparatide, her LS and TLF bone mineral density increased by 9% and 3%, respectively after 16 months and by 18% and 5%, respectively after 22 months of teriparatide therapy. Concurrently, her TRF bone mineral density was stable. Thereafter, she did not experience any new fractures and tolerated the treatment well. The only adverse event that was related to teriparatide therapy was hyperuricaemia, which resolved following dose reduction. Author comment: "This work describes the case of a 71-yr-old woman diagnosed with lupus nephropathy treated with 40 mg/d of meprednisone, and who suffered multiple vertebral fractures." "Glucocorticoid (GC) treatment is the most frequent cause of secondary osteoporosis." Mastaglia SR. Effect of Time of Administration of Teriparatide on Bone Mineral Density in Glucocorticoid-Induced Osteoporosis. Journal of Clinical Densitometry 20: 513-515, No. 4, Oct-Dec 2017. Available from: URL: http://doi.org/10.1016/ j.jocd.2017.05.005 - Argentina 803284709 0114-9954/17/1680-0001/$14.95 Adis © 2017 Springer International Publishing AG. All rights reserved Reactions 2 Dec 2017 No. 1680
Reactions Weekly – Springer Journals
Published: Dec 2, 2017
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