Endocrine Abstracts

Introduction: We report a case of severe osteoporosis with incident fragility fractures during antiresorbtive therapy in the presence of amiodarone induced hypothyroidism.

Case report: A 76 year old female was admitted in our department for the evaluation of antiresorbtive therapy in the context of a recent rib fracture after coughing. Severe osteoporosis (lumbar T-score: −2.8DS, femoral neck T-score: −2.9DS with multiple fragility fractures) was treated with i.v. Ibandronic acid and vitamin D during the last 16 months.

Her medical history consists of atrial fibrillation, hypertension, severe osteoporosis, Raynaud’s syndrome and Amiodarone induced autoimmune hypothyroidism currently under treatment with L-Thyroxine.

Clinical features: Normal BMI, kyphosis with loss of more than 5 cm of height in the last 5 years, Raynaud’s syndrome with inflammatory signs of the hands, left bronchial rales, a BP of 110/70 with a HR of 125.

Laboratory: ESR=36 mm/h, normal serum calcium and 25OH vitamin D, a TSH of 5.89 under 75 μg of L-Thyroxine.

The chest X-rays and CT showed a 4th rib fracture and a revealed T9 and T10 vertebral fractures, and also an important pulmonary fibrosis, which led to the systemic sclerosis diagnosis.

Recent reviews found that the risk of osteoporotic fracture in systemic sclerosis is similar to rheumatoid arthritis, affecting the axial skeleton and caused by the chronic inflammatory state. Consequently, due to the newly increased fracture risk (due to the systemic sclerosis and incident fracture under antiresorbtive treatment) we recommended teriparatide treatment.

Conclusion: The pathogeny of severe osteoporosis, in our case, revealed new findings after <2 years of treatment: besides advanced age and possible effects of L-thyroxine replacement therapy we discovered that the established negative effects of the systemic sclerosis on the skeleton revealed the need for a complete reevaluation during follow-ups for osteoporotic patients.