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Neurological Rehabilitation

Romosozumab increases bone mineral density in the distal femur and proximal tibia in persons with chronic spinal cord injury and sublesional osteoporosis

(Kiosk 3) Romosozumab Increases Bone Mineral Density in the Distal Femur and Proximal Tibia in Persons with Chronic Spinal Cord Injury and Sublesional Osteoporosis

Saturday, November 18, 2023
12:00 PM – 1:30 PM CT

    Primary Author(s)

  • Christina V. Oleson, MD (she/her/hers)

    Professor, Physical Medicine and Rehabilitation, and Director, Neuro-Osteoporosis Program
    MetroHealth Rehabilitation Institute of the MetroHealth System/Case Western Reserve University
    Cleveland, Ohio

    • Co-Author(s)

  • SF

    Sam Famenini, MD

    Resident
    MetroHealth System/Case Western Reserve University PM&R Program
    lakewood, Ohio

Case Diagnosis: Romosozumab increases bone mineral density (BMD) analyzed by Dual-Energy Xray Absorptiometry (DXA) in spinal cord injury (SCI) individuals

Case Description: A 39-year-old male with C5 incomplete tetraplegia for 19 years and a 63-year-old male with T11 complete paraplegia for 33 years were each diagnosed with severe sublesional osteoporosis by regional DXA.

Discussion: Following acute SCI, disuse osteoporosis rapidly ensues within the first 2 years, but smaller declines occur thereafter. Bone loss and fracture rates are highest in distal femur (DF) and proximal tibia (PT). Because each individual failed alendronate and anabolic agents were contraindicated, both received romosozumab 210mg monthly for one year, followed by antiresorptive treatment for a second year. Romosozumab is a sclerostin inhibitor that decreases osteoclastic activity. The primary outcome was BMD change following 12 months of romosozumab.

Setting: Outpatient Neuro-Osteoporosis Clinic

Assessment/Results: For our C5 tetraplegic individual, DXA after 1 year romosozumab revealed BMD in the DF increased from 0.574g/cm2 to 0.680g/cm2 (+18.4%) on the right and from 0.515g/cm2 to 0.656g/cm2 (+27.3%) on the left. In the PT, BMD increased from 0.444 g/cm2 to 0.686 g/cm2 on the right (+54.5 %) and from 0.327g/cm2 to 0.616 g/cm2 on the left (+88.37 %). Hip BMD increased by 3.57% and 17.17%, for right and left sides, respectively. In our T11 paraplegic participant, BMD changed from 0.454 g/cm2 to 0.453 g/cm2 in the right DF ( -0.22%), and from 0 .436g/cm2 to 0.470 g/cm2 on left DF (+7.8%). In his PT, BMD changed from 0.448 g/cm2 to 0.443g/cm2 on the right (-1.1%) and from 0.477g/cm2 to 0.504g/cm2 on the left (+5.7 %). Hip BMD increased by 3.3% and 12.1% on right and left sides.

Conclusion: In osteoporotic SCI individuals without cardiac or stroke risk factors, first-year DXA results show significant increases in DF and PT BMD after romosozumab, warranting its consideration. Second-year DXA results remain pending.