Vertebral fractures in a young woman: the impact of hypogonadism, glucocorticoids, and chronic disease.
Madhuni Herath, Hanh H Nguyen, Frances Milat et al.
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Case in brief
A premenopausal woman developed painful vertebral fractures while receiving prednisolone for newly diagnosed systemic lupus erythematosus. Her bone-loss risk factors included 12 years of depot medroxyprogesterone acetate use, smoking, a family history of osteoporosis, and active inflammatory arthritis. Investigations showed vitamin D deficiency and low bone mass for age and sex. Despite vitamin D treatment and changing contraception to a levonorgestrel intrauterine device, further vertebral fractures were confirmed by MRI and bone scan. After other secondary causes of low bone mass were excluded, targeted osteoporosis treatment was initiated, with zoledronic acid recommended.
What made this case unusual
The case illustrates vertebral fragility in a young premenopausal woman with several overlapping contributors, including prolonged depot medroxyprogesterone acetate exposure, SLE-related inflammation, and glucocorticoid treatment.
Diagnostic / clinical pearl
In a young adult with vertebral fractures, assess for multiple concurrent contributors to low bone mass, including glucocorticoid exposure, inflammatory disease, hormonal factors, and vitamin D deficiency.