Monoclonal antibody anti-sclerostin for treatment of pelvic insufficiency fractures in adult hypophosphatasia: A case report

Q4 Medicine Trauma Case Reports Pub Date : 2024-07-15 DOI:10.1016/j.tcr.2024.101077

Pierre-Emmanuel Schwab , Alicia Dessain , Joshua Milby

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Abstract

Hypophosphatasia is a rare inherited metabolic disease leading to inhibition of bone and teeth mineralization that can be complicated by multiple insufficiency fractures. Treatment is currently limited to enzyme replacement therapy using bone-targeting recombinant human alkaline phosphatase, or asfotase alfa. Romosozumab is a monoclonal anti-sclerostin antibody originally indicated for the treatment of osteoporosis in postmenopausal women with high-risk of fracture. Recently its indication had been expanded to other metabolic bone disorders such as osteogenesis imperfecta. We report a unique case of a 67-yer-old female with hypophosphatasia complicated by multiple delayed-union and nonunion insufficiency fractures of the pelvis. After 12-month therapy with Romosozumab to address her osteoporosis, the patient healed her fractures and increased her bone mass density. Our case report shows interesting effects of Romozumab in an adult patient with hypophosphatasia. It not only helped increase bone density, but also help in the healing process of delayed-union and nonunion insufficiency fractures of the pelvis and prevented the occurrence of new fractures during the treatment period. To our knowledge, this is the first report describing the potential effect of Romosozumab on insufficiency fractures in patients with hypophosphatasia.

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单克隆抗体抗硬骨素治疗成人骨盆发育不全性骨折：病例报告

低磷酸盐血症是一种罕见的遗传性代谢疾病，会导致骨骼和牙齿矿化受抑制，并可并发多发性功能不全骨折。目前的治疗方法仅限于使用骨靶向重组人碱性磷酸酶或asfotase alfa进行酶替代治疗。Romosozumab 是一种单克隆抗硬骨素抗体，最初用于治疗骨折风险较高的绝经后妇女的骨质疏松症。最近，该药的适应症已扩展至成骨不全症等其他代谢性骨病。我们报告了一例独特的病例，患者是一名 67 岁的女性，患有低磷酸盐血症，骨盆多发延迟愈合和非愈合不全骨折。在使用罗莫单抗治疗骨质疏松症 12 个月后，患者的骨折痊愈，骨密度也有所提高。我们的病例报告显示了罗莫珠单抗对一名患有低磷酸盐血症的成年患者的有趣疗效。它不仅有助于增加骨密度，还有助于骨盆延迟愈合和非愈合不全骨折的愈合过程，并在治疗期间防止了新骨折的发生。据我们所知，这是第一份描述罗莫单抗对低磷血症患者骨盆不全骨折的潜在影响的报告。

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来源期刊

Trauma Case Reports Medicine-Emergency Medicine

CiteScore

0.60

自引率

0.00%

发文量

131

审稿时长

26 weeks

期刊介绍： Trauma Case Reports is the only open access, online journal dedicated to the publication of case reports in all aspects of trauma care and accident surgery. Case reports on all aspects of trauma management, surgical procedures for all tissues, resuscitation, anaesthesia and trauma and tissue healing will be considered for publication by the international editorial team and will be subject to peer review. Bringing together these cases from an international authorship will shed light on surgical problems and help in their effective resolution.