Teriparatide in sequental treatment of osteoporosis in a patient with spinal muscular atrophy: a case report and literature review

• A woman with spinal muscular atrophy (SMA) type 3c experienced fragility fractures despite long-term oral bisphosphonate therapy. • Sequential treatment with teriparatide followed by risedronate led to an 11-year fracture-free period. • This is the first reported case of successful sequential teriparatide and bisphosphonate therapy in an adult SMA patient. We report the case of a female patient with spinal muscular atrophy type 3c, low bone mineral density and multiple fragility fractures, successfully treated with teriparatide. She sustained a vertebral fracture at age 35 years while treatment naïve, and additionally, one vertebral fracture as well as an intertrochanteric right hip fracture during the 5-year treatment with oral bisphosphonates. A sequential 2-year treatment with teriparatide followed by a one-year treatment with oral bisphosphonate risedronate resulted in an overall 11-year fracture-free period and stable bone mineral density. Teriparatide is an osteoanabolic medication that effectively reduces vertebral and nonvertebral fractures in postmenopausal, male and glucocorticoid-induced osteoporosis, particularly in individuals at very high risk of fracture. In the context of neuromuscular disease, teriparatide proved effective in the treatment of osteoporosis in Duchenne muscular dystrophy. In contrast, the data for patients with spinal muscular atrophy are lacking. Further studies are needed to assess its role in this population.