Patient case (clinical description): A 55-year-old white woman comes for a routine checkup.  She has no significant medical history and does not use tobacco, alcohol, or illicit drugs.  The patient's only medication is an over-the-counter multivitamin.  Family history is notable for a hip fracture in her mother.  Blood pressure is 130/80 mm Hg and pulse is 112/min. She has occasional back pain and lives a sedentary lifestyle with the BMI of 24 Kg/m2. Plain X-ray of the spine shows mild compression fracture at the level of T10. X-ray absorptiometry studies demonstrate abnormally low bone density in the lumbar vertebrae and T-score values below -2.5, which confirms the diagnosis of osteoporosis.

Patient's own account: I'm a 55-year-old white woman and I recently visited my family doctor. I don't smoke anything or drink. I don't have any remarkable medical history. I only use over-the-counter multivitamins to keep myself fresh and energized. My mom had a hip fracture. The doctor took my blood pressure and it was 130/80 and my pulse was 112/min. I have annoying back pain from time to time and to be honest I don't exercise much or move much. My BMI is 24. I did a spine X-ray a while ago and my doctor showed me that I have a fracture on one of my vertebrae. I also have a low bone density in my lumbar vertebrae and T-score values below -2.5. The doctor diagnosed me with osteoporosis.

Clinical trial: A Study in Indian Postmenopausal Women With Osteoporosis to Evaluate the Efficacy and Safety of Denosumab

Eligibility criteria:
Inclusion Criteria:

          -  Ambulatory Indian postmenopausal women with osteoporosis

          -  greater than 5 years postmenopausal

          -  aged 55 to 75 years old

          -  absolute bone mineral density value consistent with a T-score less than -2.5 and
             greater than - 4.0 at the either the lumbar spine or total hip, as measured by dual
             energy x-ray absorptiometry. Subjects with a T-score less than or equal to -4.0 are at
             very high risk for fracture and will be excluded.

        Exclusion Criteria:

          -  previous or current metabolic bone disease, Paget's or Cushing's disease, or
             hyperprolactinemia

          -  current hypo- or hyperparathyroidism or hypo- or hyperthyroidism unless on stable
             thyroid replacement therapy and TSH level meets criteria

          -  rheumatoid arthritis

          -  cirrhosis of the liver or unstable liver disease or ALT or AST greater than or equal
             to 2.0 times the upper limit of normal, or alkaline phosphatase and bilirubin greater
             than or equal to 1.5 times the upper limit of normal

          -  medications used to treat osteoporosis, defined for type and duration of use, and
             including IV and oral bisphosphonates

          -  medications that affect bone metabolism including parathyroid hormone or derivatives;
             anabolic steroids or testosterone; glucocorticosteroids; systemic hormone replacement
             therapy; selective estrogen receptor modulators; tibolone, calcitonin, and calcitriol
             or vitamin D derivatives; other bone active drugs including anticonvulsives (but not
             benzodiazepines) and heparin; chronic systemic ketoconazole, androgens, ACTH,
             cinacalcet, aluminum, lithium, protease inhibitors, methotrexate, and
             gonadotropin-releasing hormone agonists

          -  malignancy within 5 years except certain resected types

          -  malabsorption syndrome or gastrointestinal disorders associated with malabsorption

          -  abnormal calcium level

          -  vitamin D deficiency

          -  any laboratory abnormality that will prevent the subject from completing the study or
             interferes with interpretation of study results

          -  oral or dental conditions including current or past history of osteomyelitis or
             osteonecrosis of the jaw; active dental or jaw condition with requires oral surgery;
             planned invasive dental procedure; un-healed dental or oral surgery

          -  any disorder that compromises the ability of the subject to give written informed
             consent or to comply with study procedures

          -  any physical or psychiatric disorder that will prevent the subject from completing the
             study or interferes with study results

          -  known to have tested positive for HIV

          -  less than two lumbar vertebrae evaluable for DXA measurements

          -  height, weight, or girth that may preclude accurate DXA measurements

          -  drug or alcohol abuse within 12 months that interferes with understanding or
             completing the study

          -  known sensitivity to mammalian cell-derived drug products

          -  use of an investigational drug or device within 30 days of enrollment or currently
             receiving other investigational agent(s)
Female
No healthy subjects accepted to join the trial.
Subject must be at least 55 Years old.
Subject must be at most 75 Years

Eligibility (NLI label): Contradiction