Endocrine Abstracts

Osteoporosis is a skeletal condition of low bone mass and increased risk of fractures and occurs most commonly in postmenopausal women. Severe osteoporosis is characterised by the presence of fragility fractures and high mortality and morbidity. We present the case of a 21-year-old female with primary hyperparathyroidism (pHP) who, despite her young age, surprisingly presented with severe osteoporosis. The 21-year-old female was hospitalised due to a recurrent flare of Still’s disease initially diagnosed 2 years earlier and for which she had received continuous steroid treatment. During hospitalisation increased calcium levels up to 3.12 mmol/l were noted and a diagnosis of pHP was made: PTH was elevated (107 ng/l) and fractional calcium excretion rate 4.4%. As part of the pre-surgery work-up severe osteoporosis was diagnosed (T-Score of −4.5 in the lower spin and numerous atraumatic fractures Th7-12, L1-5). The patient was bedridden for several weeks due to severe pain due to inflamed joints and fractures. A parathyroid adenoma was successfully removed and calcium and PTH levels normalised, but 3 months later the patient suffered a new Th5 fracture and a therapy with denosumab was initiated. In search for additional risk factors for severe osteoporosis we could identify besides the glucocorticoid treatment, severe vitamin-D-deficiency and a history of secondary amenorrhea for 18 months with spontaneous normalisation and currently normal gonadotropin levels. There were no signs of juvenile osteoporosis and the patient had reached the expected height.

Severe osteoporosis is uncommon in premenopausal patients with primary hyperparathyroidism but can occur when multiple risk factors accumulate. Careful evaluation for risk factors of increased fracture risk should be undertaken even in young pHP patients. Little evidence is available for when to best start anabolic bone treatment post-surgery in such patients.