Endocrine Abstracts

Introduction: Depression and associated medication, especially Selective Serotonin Reuptake Inhibitors, may associate high fracture risk through serotonin (but not only). Obesity has been recently proved to be correlated with a higher fracture risk for a few sites as ankle, elbow, shoulder, etc. Moreover, depression and some anti-depressants may increase the calories intake and consecutive increased of Body Mass Index (BMI) is registered.

Aim: We present a fragility fracture medical history in a context of depression and obesity as only obvious causes of osteoporosis.

Material and Methods: The bone profile is analyzed in this case report.

Results: Fifty seven year old non-smoking female patient was diagnosed with multi-nodule goiter at age of 49 and total thyroidectomy was performed. Substitution with daily levothyroxine was continued up to present with consecutive normal TSH levels.

Menstruation stopped at 50 years; she suffered of chronic headache. At age of 53 she was diagnosed with depression and she was offered different types of anti-depressive medication for almost 3 years. At age of 56 she suffered a left elbow fracture and the circumstances of fall indicated an osteoporotic type.

Endocrine check-up was done at that moment. The patient had a BMI of 40 kg/m²; 25-hydroxyvitamin D assay showed an inadequate level of 20.8 ng/ml (N:30–100 ng/ml), with normal bone turnover markers: blood CrossLaps of 0.44 ng/ml (N:0.226–1.008 ng/ml), blood osteocalcin of 25.71 ng/ml (N:15–46 ng/ml), and circulating serotonin of 280 ng/ml (N:80–450 ng/ml). Dual-Energy X-Ray Absorptiometry showed lumbar L1-4 Bone Mineral Density (BMD) of 1.049 g/cm², T-score=−1.1 S.D., Z-score=−1.4 S.D. Weekly oral risendronat with daily vitamin D/calcium supplements were followed for 1 year: BMD increased to 1.14 g/cm², T-score=−0.3 S.D., Z-score=−0.5 S.D.

Conclusion: Obesity and depression might associate vitamin D deficiency. Depression and anti-depressants may act on fall risk by attention and gait anomalies. However, both conditions may be not associated relevant BMD changes.