Endocrine Abstracts

74 year old female presented in ED with history of fall 2 weeks ago and worsening severe back pain, unable to weight bear. She has background history of hypertension, epilepsy and chronic back pain. She had distal radial fracture in 2016, and Dexa scan at that time showed osteopenia with T-score of −1.8, but she was not receiving conventional osteoporosis treatment (e.g., bisphosphonates), hormone replacement therapy, or using natural or synthetic steroids. Furthermore, she did not have a history of rheumatoid arthritis, Paget’s disease, type 1 or type 2 diabetes, or primary hyperparathyroidism. On examanition she was haemodynamically stable. No focal neurology and tender over mid to lower back. No sphincter involvement. Bloods showed raised calcium level of 2.94 mmol/l, phosphate 0.65 mmol/l. Alkaline phosphatase was normal, Renal functions were normal, Vitamin D was low at 10.4 ng/ml. CT-scan spine was done which showed multiple recent osteoporotic fractures at T12, L1 and L5, and old fractures at L2, L3 and L4. Her Dexa scan was repeated which showed T-score of −3.1. Due to raised calcium her PTH levels were done which were raised to 10.6 pmol/l. She was started on analgesia, bisphosphonates and Vitamin D replacement and further plan was to investigate for primary hyperparathyroidism.