Endocrine Abstracts

JOINT2034

We present a case of a 31-year-old woman who was admitted to the Department of Endocrinology, Diabetes, and Isotope Therapy due to multiple vertebral fractures 6 months after delivery of her first child. The patient had been diagnosed with autoimmune thyroid disease with normal thyroid function before pregnancy. Treatment with levothyroxine was started in the 22nd week of gestation and continued until 6 weeks after delivery. She received vitamin D, iodine, and folic acid supplementation during pregnancy and lactation. She breastfed on demand. The patient does not smoke or abuse alcohol. Three months after delivery, the patient had a strong thoracolumbar pain while she was lifting a baby. On X-ray, scoliosis, L3-L4 discopathy, bone atrophy, and multiple vertebral fractures were depicted. Densitometry at the lumbar spine revealed osteoporosis Z-score (-) 4.8. Chest X-ray, ultrasound of breast, abdomen with pelvis, and bone scintigraphy did not reveal abnormalities. Thoracic and lumbar spine magnetic resonance imaging revealed fractures (Th4, Th7, Th9, Th12 and L1). The patient was treated with vitamin D (2000 IU a day) and calcium (1.5 g a day). A spine corset and rehabilitation were recommended but did not decrease thoracolumbar pain. On admission, the patient’s BMI was 18.75 kg/m². Osteoporosis at the lumbar spine (Z-score (-) 4.8) and femoral neck (Z-score (-) 2.9) was confirmed. During hospitalization, laboratory tests revealed normal levels of calcium, phosphates, parathormone, vitamin D, and bone turnover markers. There were no hormonal disturbances. Non-endocrine causes for secondary osteoporosis were also excluded. Finally, the patient was diagnosed with pregnancy and lactation-associated osteoporosis (PLO). Treatment with higher doses of vitamin D (4000 IU a day) and calcium (2.0 g a day) was initiated. After 8 months bone density parameters improved and the patient reported back pain relief.