Case 2

Case 2

Dr. Sayed Mahmoud Sajjadi

Associate Professor of Endocrinology

Shariati hospital

TUMS

EMRI

Hypothetical scenario A

• A 70-year-old woman with osteoporosis referred to you due to right hip fracture.
• Dx: Calcium and vitamin D.
• Examination: she has lost 1 inch in height.
• Imaging: Two biconcave vertebral compression fracture at T10 and T12 that seem to be old.
• The DXA:
  • T-scores of –2.9 at L1-L4, –2.9 at the left FN, and –2.7 at the left TH
• laboratory work up: 24 hour urine free cortisol, serum tryptase, serum and urine protein electrophoresis, and PTH comes back negative. Other routine lab: NL        

Hypothetical scenario B

• A 72-year-old woman with osteoporosis comes to see you with acute mid back pain after lifting a bag of mulch.
• Dx: ALN 70 mg weekly for 4 years followed by DMAB 60 mg sc every 6 months for the past 18 months. plus calcium and vitamin D.
• Examination: mid back is tender and she has lost 1 inch in height.
• Imaging: an acute biconcave vertebral compression fracture at T10 and mild-to-moderate anterior wedge compression fractures at 2 other vertebrae that seem to be old.
• last DXA from 6 months ago:
  • T-scores of –2.5 at L1-L4, –2.8 at the left FN, and –2.5 at the left TH.        
  • All were significantly improved compared with the previous scan
• laboratory work up: 24 hour urine free cortisol, serum tryptase, serum and urine protein electrophoresis, and PTH comes back negative. Other routine lab: NL. Fasting serum CTX is suppressed.