Title: August 2017 – BMD Changes After Withdrawal from Long Term Bisphosphonates

Submitted By: Lawrence Jankowski, CBDT
Affiliation: Illinois Bone and Joint Institute, LLC. Morton Grove, Illinois USA

Patient History:
A 76-year-old Caucasian female, Height: 65”, 105 lb, (BMI = 17.5). Pelvic insufficiency fracture from minor fall. Other FRAX related risk factors include maternal hip fracture, 3 units of alcohol daily. She returns for a follow-up DXA scan 30 months after her fifth annual intravenous dose of zolendronic acid 5mg. Bilateral hip and spine scans were performed to determine stability of bone density off medication. Based on lowest femur neck BMD, her current 10 year probability of major osteoporotic/hip fracture risk are 20.9% and 9.3% respectively. Patient concerned about resuming bisphosphonates over side effects and she has developed gradually worsening bilateral hip pain, right worse than left, since last dose of zolendronic acid. Images of bilateral hips and spine from current study (Figures 1-2) and changes from prior study (Figure 3) are shown below.


Figure 1: Bilateral femur scans from current visit.


Figure 2: Spine L1-L3 (2017) L4 was deleted from prior study as well for T-score discordance >1 SD


Figure 3: Rate of Change table for hips and spine. NS denotes not statistically significant. “*” denotes the changes are greater than the LSC for those regions determined by in-vivo precision assessment for the facility.

Questions:

  1. Are the changes in BMD noted consistent with the medical history?
  2. What is the most likely etiology for the discordant changes in BMD between the various regions of interest?
  3. Are the FRAX 10- year fracture risk scores reflective of this patient’s fracture risk?

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