Pediatric Rheumatology Online Journal → August 2003 → Bone → Abstract #146
IDIOPATHIC JUVENILE OSTEOPOROSIS (IJO). A 7 YEAR FOLLOW UP CASE
V. C. S. Ramos, C. M. M. Albertini, D. A. B. Buttros, G. S. Novaes, M. T. Aidar
1Department of Rheumatology, Pontific Catholic University of Sao Paulo, Sorocaba, SP, Brazil
IJO is a transitory osteometabolic disease described as diffuse osteoporosis
with bone fractures. The etiology is unknown and diagnostic made by exclusion of
other causes. Its course is considered self-limited with spontaneous recovering
after pubertal maturation. We report a case with 7 years of clinical evolution
and still without resolution.
A 10 year-old caucasian boy got pain in the
right foot, ankles and knees that worse while walking, with progressive course.
His physical examination disclosed muscle atrophy of lower limbs. Otherwise, his
physical and mental development was normal. Ankles and knees X-ray showed
diffuse osteopenia. Lumbar spinal X-ray disclosed flatten vertebra. Urinary
calcium was increased (312 mg/24h). At this time, the following laboriatorial
test determination were realized: WBC, ESR, ANA, rheumatoid factor, serum
protein eletrophoresis, phosphorus, calcium, cortisol and calcitonin,
urinanalysis, faecal lipids, antigliadin antibody, PTH, and Thyroid hormones,
which were all at normal range.
The BMD is expressed as g/cm
BMD(Jan 97) L2-L4 0,292
BMD(May 99) L2-L4 0,745
BMD(Oct 02) L2-L4
1,035
BMD(Jan 97) Neck 0,242
BMD(May 99) Total body 0,808
BMD(Oct 02) Total body 0,967
During these 7 years he had fractures in right and left femoral
bone with epifisary sliding and in second metatarsus of right foot.The interval
between these fractures was 6 months and were antedated by minor traumas. He
evolved without complaints, but with low stature. He was treated with vitamine D
and calcium carbonate for 4 years and sodium alendronate in a dose of 10 mg/day
for 2 years. In october 02, sexual hormones (testosterone,FSH,LH) were
determinated and the results point out the patient had achieved adulthood, but
remains with persistent osteoporosis.
The findings here described are against
statements found previously in medical literature that IJO has spontaneous
recovery after pubertal maturity.