Endocrinol Metab.  2012 Dec;27(4):334-339. 10.3803/EnM.2012.27.4.334.

A Case of Multiple Osteoporotic Compression Fractures in Young Man with Budd-Chiari Syndrome

• Kim SH
• Yang TU
• Choi BK
• Yoo HJ
• Seo JA
• Choi KM
• Kim NH
• Kim SG
• Baik SH
• Choi DS
• Choi HY

• KMID: 1973800
• DOI: http://doi.org/10.3803/EnM.2012.27.4.334

Abstract

Osteoporosis in young men is extremely rare. In this report, we demonstrate a rare case of multiple vertebral fractures discovered in a young man with Budd-Chiari syndrome without prior history of trauma. A 29-year-old man was diagnosed as Budd-Chiari syndrome 12 years ago and underwent a mesocaval shunt to relieve the hepatic vein obstruction and was on warfarin therapy. He suffered from low back pain and it was not relieved by analgesics. A T-L spine X-ray revealed multiple compression fractures and the z-score at lumbar spine was -3.7 which is below the expected range for that age. The patient was treated with calcium, vitamin D and bisphosphonate, and showed clinical improvement. This case highlights the importance of the investigation for secondary osteoporosis in young adults with an underlying disease that alters bone metabolism.

Keyword

Budd-Chiari syndrome; Liver cirrhosis; Osteoporosis

MeSH Terms

Adult
Analgesics
Budd-Chiari Syndrome
Calcium
Fractures, Compression
Hepatic Veins
Humans
Liver Cirrhosis
Low Back Pain
Multiple Endocrine Neoplasia Type 1
Osteoporosis
Spine
Vitamin D
Warfarin
Young Adult
Analgesics
Calcium
Vitamin D
Warfarin

Figure

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  Fig. 1 The simple X-ray images of the patient. (A) Abdominal plain film shows mild scoliosis and stent of mesocaval shunt. (B) Lateral plain film shows multiple compression fractures at T7 through L4.

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  Fig. 2 Computed tomography image of T-L spine shows multiple compression fractures at T7 to L5 spine.

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  Fig. 3 Bone scan shows hot uptake at right 4th, 10th ribs and left 2nd, 5th, and 8th ribs. Diffuse hot uptake at T7 to L5 vertebrae is also noted.

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  Fig. 4 Bone densitometry demonstrates low bone mineral density at lumbar spine and right femur.

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