Endocrine Abstracts

Background: Glucocorticoid-induced osteoporosis is common in chronic diseases as inflammatory bowel disease. Although BMD (bone mass density) is used for the estimation of the quantity of the bone, on the contrary, TBS (trabecular bone score) is a new parameter, a gray-level textural assessment of bone microarchitecture, providing estimation of quality of bone. Several studies showed increased level of TBS during teriparatide treatment in glucocorticoid induced osteoporosis.

Case report: We report the case of a 23-year-old female, diagnosed with Crohn disease in 2014, initially managed with ileal resection and subtotal colectomy. In august 2018, she was performed DXA (dual energy-X ray absorptiometry) that revealed BMD spine=0.883 g/cm², Z score=−2.4 DS, TBS=1293. The X-ray of the spine showed L2 compression. At that moment she had stable disease on treatment- Crohn disease activity disease CDAI=130 on prednisolone 24 mg/day, anti TNF, Imuran. Bone markers were crosslaps=0.09 ng/ml and osteocalcin =9.1 ng/ml, with normal endocrine assessment. After 6 months of treatment, she increased methyl prednisolone, receiving 48 mg/day, lost 6 kilos and stopped anti TNF treatment, and her CDAI was 220 (mildly to moderate disease); she was on teriparatide for 6 months and Vitamin D 2000 UI/day. Although DXA scan revealed increased BMD spine=0.948 g/cm² (+6.5%), Z score=−2 DS, TBS decreased=1,269 (−2.4%). Crosslaps were 0.14 ng/ml and osteocalcin 8.3 ng/ml.

Conclusion: Treatment with teriparatide can be efficient in Crohn disease, but in case of disease severity and high dose glucocorticoid treatment, TBS may represent a more sensitive and precocious marker of negative change in bone mass, as shown by bone markers.