Endocrine Abstracts

A 43 year old female experienced sudden sever back pain after lifting her baby’s buggy in January 2014. In October 2013, she had an emergency caesarean section to deliver her baby. This was performed for a prolonged first stage of labour with foetal distress. She breast fed her baby for 16 weeks. Her baby was conceived in early 2013 on the first attempt using donor egg and sperm. Her husband was found to have azoospermia. They therefore approached a Fertility Clinic and started trying to have a baby when the patient herself was in her late 30’s. By that stage, she was already experiencing irregular periods and occasional hot flashes. Her FSH was 23.1, AMH 0.07 and a trial of Clomiphene was unsuccessful. Her last menstrual period was in December 2012 and periods never returned after stopping breastfeeding. Menarche was at the age of 15. She was found to have multiple vertebral fractures on MRI spine. She had DEXA scan which revealed severe osteoporosis with T score −4.4 at lumbar vertebrae and T score −2.7 at hips. She was initially given oral bisphosphonate and Hormone Replacement Therapy (HRT) but after few months bisphosphonate was stopped and Teriparatide was started in August 2014, HRT was continued. Secondary causes of osteoporosis were ruled out. She also had Kyphoplasty done at levels T8, T10, T12, L1, L2, L4 and L5. She had 2 years of Teriparatide treatment. DEXA scan after treatment improved significantly and revealed T score −0.7 at L2-L4 and mean femoral −1.1. HRT was continued after stopping Teriparatide. She had repeat DEXA scan in January 2018 and T score −0.8 at L2-L4 and mean femora T score is also −0.8. She had repeat MRIs of spine and no new change was noted. This patient had very good response to Teriparatide and BMD remains stable on HRT after stopping Teriparatide.