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Kidney Week

Abstract: PO0398

Successful Treatment of Severe Osteoporosis with Romosozumab in a Patient Undergoing Combined Peritoneal Dialysis and Hemodialysis: A Case Report

Session Information

Category: Bone and Mineral Metabolism

  • 402 Bone and Mineral Metabolism: Clinical

Authors

  • Lee, Hyeryong, Kyorin Daigaku, Mitaka, Tokyo, Japan
  • Fukuoka, Kazuhito, Kyorin Daigaku, Mitaka, Tokyo, Japan
  • Kaname, Shinya, Kyorin Daigaku, Mitaka, Tokyo, Japan

Group or Team Name

  • Kyorin University School of Medicine, Department of Rheumatology and Nephrology
Introduction

Recently osteoporosis is becoming a bigger problem as aging of dialysis population progresses. However, the use of anti-osteoporotic drugs is limited because of concerns for increased rates of adverse events associated with decreased drug clearance and comorbidities such as CKD-MBD in dialysis patients. Here we present a case of severe osteoporosis that was successfully treated with romosozumab.

Case Description

A 57-year-old woman ESKD patient due to lupus nephritis had been on peritoneal dialysis (PD) combined with hemodialysis for the last 4 years. She has been suffering from systematic lupus erythematosus and complicated by severe osteoporosis probably due to long-term use of glucocorticoids and renal dysfunction. Although she was treated with vitamin D3 analogues, bisphosphonates, and denosumab, severe pains continued and had pelvic bone and vertebral fractures, followed by repeated pathological bone fractures of the ribs. Thus, we decided to use romosozumab. After administration of romosozumab, bone pains dramatically improved and fragile bone fractures became less frequent, without progression of bone destruction. Four months later levels of tartrate-resistant acid phosphatase-5b decreased, total type 1 procollagen N-terminal propeptide increased, and bone mineral density significantly improved. Serum calcium and inorganic phosphate levels slightly decreased, and intact PTH slightly increased, but no overall adverse effects were noted.

Discussion

Romosozumab is a humanized anti-sclerostin monoclonal antibody that has recently been introduced for the treatment of osteoporosis. While it demonstrates strong effects on osteogenesis and bone reabsorption, it also raises concerns about increased cardiovascular events. Our case suggests that romosozumab can be safely and effectively used for the treatment of osteoporosis, at least for a short period, in patients undergoing dialysis, although further study is clearly required to evaluate the efficacy of the agent.