PMC9876712_01
Outline of the clinical course from 2009 to 2016. The figure shows changes in serum alkaline phosphatase (IU/L) (red line), tartrate-resistant acid phosphatase 5b (mU/dL) (blue line), and the bone mineral density T score (lateral lumbar spine).
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The BMD had increased (T score, -2.2 SD) at 4 years after starting the administration of teriparatide (2 years of treatment with teriparatide and 2 years of sequential treatment with minodronate) (Fig. 1).
PMC9876712_02
Bone biopsy findings. a: Overview of a bone biopsy one year after the termination of teriparatide treatment and the administration of minodronate. Tetracycline double labeling was used (200 mg/day doxycycline: 3 days on, 12 days off, 3 days on, 66 days off). The frame of the cortical bone was thin, and the bone volume of cancellous bone was lower than in younger age groups. In many areas, broken bone fragments were observed, probably due to the biopsy, suggesting fragility. Square b shows b. Square c shows c. b: No tetracycline labeling was seen on most of the trabecular surfaces in cancellous bone (b-C). Empty lacunae without osteocyte nuclei were observed in the lacunae of bone trabeculae (arrows, b-D). The patient was diagnosed with adynamic bone. c: In cortical bone, double tetracycline labeling (arrows) was seen along the trabecular surfaces (c-C), and the markedly thickened osteoid layer (black arrows) was covered by numerous osteoblasts (red arrows, c-D).
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However, broken bone fragments were observed in many areas, probably due to the biopsy, suggesting fragility of the bone (Fig. 2a). Empty lacunae without osteocyte nuclei were observed in the bone lacunae of bone trabeculae (Fig. 2b). In cortical bone, double tetracycline labeling was seen along the trabecular surfaces, and the markedly thickened osteoid layer was covered by numerous osteoblasts (Fig. 2c).