Endocrine Abstracts

Osteoporosis is defined as a skeletal disorder characterised by reduced bone mineral density, predisposing a person to an increased risk of fracture. An estimated 3 million people in the UK suffer from the condition, most of these are women. Early intervention is important because bone loss is progressive and so is the risk of fracture.

A 28 year old lady presented to a local hospital complaining of pain in her right hip which caused her to limp. She was noted to be floridly Cushingoid and referred to the endocrinologists. X-rays demonstrated an impacted fracture of the right hip and bilateral stress fractures of the pubic rami. X-rays of the lumbar spine were suggestive of osteoporosis.

Her Cushing’s disease was treated initially with pituitary hypophysectomy. She had a successful operation on her hip and was given a bisphosphonate for the osteoporosis.

A subsequent recurrence of her Cushing’s disease required bilateral adrenalectomy. The patient’s latest bone densitometry scan demonstrates persisting osteopaenia, and she has had vertebral crush fractures of T9/10. A rib fracture occurred during a chest infection.

Exposure to excess glucocorticoid poses a recognised risk to the skeleton. Osteoporosis treatment in this lady was complicated by the recurrent nature of her Cushing’s disease and her young age at presentation.