Multidisciplinary approach in the treatment of a comorbid patient with secondary osteoporosis - a clinical case report
Abstract
The case report describes the course of monitoring and treatment of a patient with secondary osteoporosis. Prior to his referral to an outpatient center for bone diseases of the University Hospital Pilsen, the patient had sustained an L2 compression fracture.
Upon admission, he was diagnosed with Graves-Basedow thyrotoxicosis; bone densitometry (DXA) revealed osteoporosis and laboratory analyses showed elevated bone turnover markers. Treatment for both thyrotoxicosis and osteoporosis was initiated.
As the condition was complicated by gastroduodenal ulcer disease, treatment with oral bisphosphonates was changed to therapy with strontium ranelate. Initially, bone mineral density (BMD) increased but after 3 years of strontium ranelate therapy, low-trauma fracture of the upper surface of the L4 body occurred and BMD decreased.
The condition was characterized as therapy failure and i.v. bisphosphonates were initiated. In 2015, another DXA scan showed a further decrease in BMD, contributed to by the metastatic process of urologocal origin in the skeleton.
Therefore, the patient was referred to outpatient care at an oncology and radiotherapy department of the UniversityHospital (denosumab therapy).