Endocrine Abstracts

Fragility fractures in the young individual are an uncommon clinical scenario and when faced with such a situation, appropriate assessment is required to ensure correct diagnosis of the underlying aetiology and to avoid unnecessary interventions. Although, primary causes of osteoporosis such as osteogenesis imperfecta are considered rare, this group of conditions has considerable phenotypic and genotypic heterogeneity and may be underdiagnosed. However, the majority of the young people with fragility fractures have a secondary cause as the underlying aetiology. This may include a range of chronic diseases and medications that can impact on bone turnover, modelling or bone mineral homeostasis. Given the increasing prevalence of young adults with childhood-onset chronic disease, it is likely that a higher number of people with such conditions will require an assessment of bone health in early adulthood. The diagnosis of osteoporosis in the young adult remains contentious. In growing children, interpretation of results and changes need to take into account the differences in stature, growth and pubertal development as well as the poor evidence that exists in this population for DXA BMD as a predictor of fractures. The ISCD recommends that people up to the age of 19 years should not be diagnosed with osteoporosis solely based on low BMD by DXA and has placed a greater focus on the presence of pathological fractures, especially vertebral, such that the diagnosis of vertebral fractures alone is indicative of osteoporosis in the younger individual regardless of DXA parameters. A stronger emphasis on vertebral morphometry, is therefore, becoming more routine in the assessment of osteoporosis. With technological advances in imaging as well as greater availability in the health care sector, it is also possible that identification of osteoporosis will reduce its reliance on techniques such as DXA in favour of other modalities that can provide a ‘virtual bone biopsy’ such as high resolution MRI or CT.

Disclosure: The Medical Fund of the University of Glasgow

The Chief Scientist Office of Scotland

The Government of Libya.