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Endocrine Abstracts (2023) 94 P322 | DOI: 10.1530/endoabs.94.P322

1Section of Investigative Medicine, Department of Metabolism, Digestion and Reproduction, Imperial College School of Medicine, Imperial College London, London, United Kingdom. 2Imperial College NHS Healthcare Trust, Department of Endocrinology, London, United Kingdom

A 58 year-old man presented with backache and was found to have T10-T12 vertebral fractures on spinal-MRI. He was diagnosed with osteoporosis on a DEXA-scan (lumbar-spine T-score-2.6) and was treated with Alendronate and Cholecalciferol at a neighboring hospital. He was referred to the endocrine bone-clinic for a second opinion regarding his osteoporosis. He had a history of multiple small bone fractures and Brucellosis that required a 2-month bed-rest. His family history included early-onset osteoporosis in his father and brother. He didn’t consume excessive alcohol nor smoke and had no hypogonadal symptoms/signs. Investigations excluded secondary causes of osteoporosis; he had a mildly elevated PTH (8 pmol/l) [ref.1.6-7.2] and low-normal adjusted-calcium (2.34 mmol/l) [ref. 2.2-2.6]. Endocrinopathy and haematological screens were unremarkable; (Hb 154 g/l [ref. 130-168], phosphate 1.01 mmol/l [ref. 0.80-1.50], ALP 65 U/l [ref. 30-130], normal renal/thyroid function, 25(OH)Vitamin-D 50 nmol/l [ref. 50-150], LH 4.3 U/l [ref. 2-12], testosterone 16 nmol/l [ref. 10-30]. He had an elevated 24-h urinary-calcium (10.1 mmol/24h [ref. 2.5-7.5]), which in the absence of other hypercalciuria causes, suggested Idiopathic Hypercalciuria as the main cause of osteoporosis. Other risk factors included the prolonged bed-rest during Brucellosis and family history of osteoporosis. A renal-ultrasound did not show nephrolithiasis or nephrocalcinosis. The patient was started on Indapamide MR (1.5mg once-daily) and was advised to maintain a low-salt diet and high fluid intake (≥2L/day). A repeat DEXA scan 3-years after Alendronate and 1-year of Indapamide treatment showed improvement in the bone mineral density (osteopenia in the lumbar spine;T score -1.9). This case demonstrates the importance of investigating for secondary causes of osteoporosis, especially in young men. It highlights the relevance of family history, as Idiopathic Hypercalciuria is associated with a higher polygenic risk of osteoporosis in first-degree relatives.

Volume 94

Society for Endocrinology BES 2023

Glasgow, UK
13 Nov 2023 - 15 Nov 2023

Society for Endocrinology 

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