Endocrine Abstracts

Long bone fractures are quite common in teenagers during rapid growth, due to the lag between longitudinal growth and cortical consolidation and trabecular structure. Vertebral fractures are uncommon in young people, and should always raise concern. A low trauma fracture is defined as a fall from standing height or less, but it is important to take a good history of the mechanism of fracture, and any previous fractures. Family history is important too. Causes of bone fragility in young people include malabsorption or poor nutrition, inflammatory disease and steroid treatment. Less common are postpartum osteoporosis and inherited disorders of bone metabolism. Look for clinical features of osteogenesis imperfecta or hypermobility syndromes and endocrinopathies. Measure bone mineral density and test for underlying causes of bone fragility (Calcium, phosphate, alkaline phosphatase, vitamin D, FBC, ESR, coeliac antibodies, TSH). Bone turnover markers are not very helpful in people before peak bone mass, because bone turnover is still high. Bone biopsy can be helpful in quantification of bone turnover and identification of mineralisation defects and rare diseases if there is real diagnostic and management uncertainty, but often doesn’t add new information.