Romosozumab improves low bone mineral density in a postmenopausal woman undergoing chronic hemodialysis and treated with a calcium-sensing receptor agonist
Masatomo Ogata,
Shu Ushimaru,
Rie Fujishima,
Hirofumi Sumi,
Kazuhiro Shiizaki,
Naoto Tominaga
Affiliations
Masatomo Ogata
Division of Nephrology and Hypertension, Kawasaki Municipal Tama Hospital, 1-30-37, Syukugawara, Tama-ku, Kawasaki, Kanagawa 214-8525, Japan; Division of Nephrology and Hypertension, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1, Sugao, Miyamae-ku, Kawasaki, Kanagawa 216-8511, Japan
Shu Ushimaru
Division of Nephrology and Hypertension, Kawasaki Municipal Tama Hospital, 1-30-37, Syukugawara, Tama-ku, Kawasaki, Kanagawa 214-8525, Japan; Division of Nephrology and Hypertension, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1, Sugao, Miyamae-ku, Kawasaki, Kanagawa 216-8511, Japan
Rie Fujishima
Division of Nephrology and Hypertension, Kawasaki Municipal Tama Hospital, 1-30-37, Syukugawara, Tama-ku, Kawasaki, Kanagawa 214-8525, Japan; Division of Nephrology and Hypertension, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1, Sugao, Miyamae-ku, Kawasaki, Kanagawa 216-8511, Japan
Hirofumi Sumi
Division of Nephrology and Hypertension, Kawasaki Municipal Tama Hospital, 1-30-37, Syukugawara, Tama-ku, Kawasaki, Kanagawa 214-8525, Japan; Division of Nephrology and Hypertension, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1, Sugao, Miyamae-ku, Kawasaki, Kanagawa 216-8511, Japan
Kazuhiro Shiizaki
Department of Nephrology, Yurina Medical Park, 662-3, Marubayashi, Nogi-machi, Shimotsuga, Tochigi 329-0111, Japan
Naoto Tominaga
Division of Nephrology and Hypertension, Kawasaki Municipal Tama Hospital, 1-30-37, Syukugawara, Tama-ku, Kawasaki, Kanagawa 214-8525, Japan; Division of Nephrology and Hypertension, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1, Sugao, Miyamae-ku, Kawasaki, Kanagawa 216-8511, Japan; Corresponding author at: Division of Nephrology and Hypertension, Kawasaki Municipal Tama Hospital, Kawasaki, Japan.
Preventing osteoporotic fractures is an issue requiring urgent attention to reduce mortality. However, unlike chronic kidney disease-mineral and bone disorder (CKD-MBD), osteoporosis is inadequately addressed in patients undergoing chronic dialysis. In fact, little is known about the proper use of anti-osteoporotic drugs for patients with CKD-MBD. A recent study showed that romosozumab, an anti-osteoporotic drug, increased bone mineral density in osteoporotic patients on hemodialysis without clinically significant adverse events. However, the efficacy and safety of coadministering romosozumab with a calcium-sensing receptor (CaSR) agonist, a pivotal drug used in the management of CKD-MBD, remain unclear. Here, we report the case of a postmenopausal woman undergoing chronic hemodialysis and treated with add-on romosozumab for osteoporosis to CaSR agonist for secondary hyperparathyroidism. After 1 year of treatment, her bone mineral density increased; however, hypocalcemia occurred during the treatment. These results suggest that the concomitant use of romosozumab with CaSR agonist may be a possible treatment option for severe osteoporosis in postmenopausal women receiving chronic hemodialysis with a high fracture risk, but serum calcium levels should be monitored closely and those at risk of ectopic calcification might not be ideal candidates for such treatment.
