Teriparatide Treatment Following Osteoporotic Hip Fracture in a Male Patient with Multiple Sclerosis and Current Recommendations

A 58-year-old male patient with a diagnosis of multiple sclerosis (MS) who had been operated due to a low-energy subtrochanteric femoral\udfracture was admitted in order to plan anti-osteoporotic treatment and rehabilitation at post-operative first week. Although the patient had\uda history of glucocorticoid use, he had never received any preventative treatment for osteoporosis. T-scores detected by Dual energy x-ray\udabsorptiometry (DXA) method were -4.7, -4.9 and -3.3 at femoral neck, total hip and L1-L4 vertebrae, respectively. Since the patient had\udsevere osteoporosis, teriparatide treatment was planned. Following vitamin D supplementation, teriparatide 20 mcg/day was started. After 6\udmonths of treatment, patient improved significantly in terms of symptoms and DXA scores. T-scores of the femoral neck, total hip and L1-L4\udvertebrae improved to -3.4, -3.9 and -3.0, respectively. When teriparatide therapy was continued up to 18 months, further increase in DXA\udvalues was observed (T-scores of femoral neck, total hip and L1-L4 vertebrae were -2.9, -2.4 and -2.2, respectively). No adverse event was\udseen during the treatment period. Following the cessation of teriparatide therapy, alendronate and cholecalciferol combination (70 mg/2800\udIU) was started. Bone health and vitamin D level are affected negatively in patients with MS due to multifactorial reasons. In order to avoid\udserious consequences such as hip fracture, awareness about osteoporosis should be increased and preventative strategies should be tailored\udfrom the early stages of the diseas