Endocrine Abstracts

An 82-year old female with known osteoporosis was reassessed for bone mineral density (BMD) measurement. Her baseline BMD and lumbar spine T-score (L1-L4) measured in 2004 was 0.699 g/cm², –3.5 SD, total left hip T-score was 0.618 g/cm², –2.7 S.D. She was treated with alendronate 70 mg, cholecalciferol 7000 IE per week and calcium supplements for some years. On follow-up in 2013 DXA of lumbar spine and hip, BMD of lumbar spine L1-L4 was 0.910 g/cm², T-score was –1.2 SD. BMD and lumbar vertebrae T-scores for a single lumbar vertebra were: L1 1.384 g/cm²,+4.2 SD; L2 0.667 g/cm², –3.3 S.D.; L3 0.654 g/cm², –3.9 S.D.; L4 0.785 g/cm², –3.0 S.D. The BMD and T-score of the neck were 0.463 g/cm², –3.5 S.D. and of the total hip 0.590 g/cm², –2.9 S.D. The images revealed a calcified mass in the L1 vertebral projection. The DXA scan analysis was repeated and the calcified formation in the L1 vertebra was excluded. BMD of analyzed lumbar spine (L2–L4) was 0.701 g/cm², T-score was –3.4 S.D. BMD and T-scores were: L2 0.614 g/cm², –3.8 S.D.; L3 0.642 g/cm², –4.0 S.D.; L4 0.785 g/cm², –3.0 S.D. In 2018, BMD of analyzed lumbar spine (L3–L4) was 0.911 g/cm², T-score was –1.7 S.D. BMD and T-scores were: L3 0.976 g/cm², –1.0 S.D.; L4 0.845 g/cm², –2.5 S.D., superposition of calcified formation was on L1+L2. Abdominal CT scans revealed a 3 cm large calcified Echinococcal cyst (EC) that was unnoticed in 2004. 2013 DXA scans show the EC projected to the L1 and those made in 2018 EC is seen on L1+L2+L3 because of the development of kyphosis, and consequently due to height reduction of 9 cm over the period of 14 years. Hip BMD was stable; the 10-year fracture risk for major osteoporosis fracture was 16% and 7.5% for hip fracture. Discussion. The study showed that calcium carbonate pills and bra wires positioned lateral to the spine can change BMD. Several medical conditions, such as osteoarthritis, ankylosing spondylitis, vertebral fractions, osteophyte formation, and aortic calcifications can also increase BMD. In our case, the patient’s hip BMD decreased by –1.8% and increased by 51.3% in L1-L4 without corrections on account of EC in the period of 14 years.