Recovery from immobilisation-associated osteoporosis with anti-resorptive and anabolic therapy.

The detrimental effects of immobilisation on bone health are well known and have been studied primarily in inpatient and long-term care settings. We describe a case seen in the osteoporosis clinic involving a patient with profound bone loss and hypercalcaemia secondary to chronic immobilisation in the setting of a debilitating systemic inflammatory myopathy. While undergoing treatment with bisphosphonate, her hypercalcaemia resolved, and no further bone loss was found based on bone turnover markers. Treatment of the underlying myopathy permitted significant recovery and return to ambulation, but with persistent very low bone density. To try to regain the lost bone mass, she was started on romosozumab. After 1 year of treatment, repeated measurements of bone mineral density showed an increase of 6% in her lumbar spine and 11% in her hip, respectively. Romosozumab use showed a significant recovery of nearly half of her original bone loss after her initial treatment with bisphosphonates.