Endocrine Abstracts

Osteoporosis is a systemic skeletal disease characterized by a decrease in bone strength and an increased risk of fractures. In the structure of osteoporosis, secondary osteoporosis is 5% in women and 20% in men. Clinicians need to exclude the secondary nature of osteoporosis, since under the ’mask’ of mineral metabolism disorders, more rare and dangerous diseases can arise. A 65-years-old women presents with complaints of three low-traumatic fractures in the last year. From the anamnesis: in 2018 she consulted a traumatologist with complaints of back pain and increased fatigue. Dual-energy X-ray absorptiometry (DXA): compression fractures of the 2nd and 3rd lumbar vertebrae, a decrease in bone mineral density (BMD) in the lumbar part of vertebral column (T-score -2.5). A diagnosis of postmenopausal osteoporosis was made, therapy with zoledronic acid was recommended, however, due to the high cost of the drug, calcium and vitamin D therapy was chosen. In March 2020, a low-traumatic fracture of 2 ribs was developed (VIII rib on the left, IX rib on the right). In July 2020, there was a fracture of the scaphoid on the right. Due to persistent complaints, the patient consulted an endocrinologist. Physical examination: BMI-27 kg/m², BP-135/80 mmHg, HR-68 beats per minute, pale skin and visible mucous membranes, musculoskeletal system without visible deformation, muscle tone is normal, risk of falls on the Morse scale is high (55 points). She denies taking medications that affect BMD. DXA was performed: BMD was reduced in the lumbar part of vertebral column (T-score – -2.5), in the area of the femoral neck (T-score – -2.6). Was calculated the FRAX: the risk of major osteoporotic fracture was 22% ten-year risk of hip fracture-4.3%. Due to the presence of atypical localization fractures an additional examination to exclude secondary causes of osteoporosis was performed: primary hyperparathyroidism, vitamin D deficiency were excluded. However, anemia (hemoglobin-95 g/l) and accelerated ESR (40 mm/h) were detected, which in combination with osteoporosis can be clinical manifestations of paraproteinemia, so the patient was referred to a hematologist. After an additional examination a diagnosis of multiple myeloma was made. The patient is currently receiving chemotherapy. Differential diagnosis of osteoporosis must be carried out in the early stages of the disease in order to exclude secondary osteoporosis and identify pathologies accompanied by a violation of mineral metabolism. Identification of reliable causes of osteoporosis allows prescribing timely etiotropic therapy, which ultimately improves the prognosis of such patients.