Osteoporosis in an 11 year old: a case report

CASE REPORTS

Osteoporosis in an 11 year old: a case report

Moras KJ, Mundkur SC, George DM, Pereira RA.

Department of Paediatrics, Kasturba Medical College, Manipal Academy of Higher Education(MAHE), Manipal, Karnataka, India.

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Abstract
An 11-year-old male child presented with progressive back pain for 2 months and compression fracture of D7 vertebra. On examination, the child had no pallor, lymphadenopathy, or organomegaly. The child had lower lumbar tenderness. Peripheral smear showed no blasts. Further investigations showed osteoporosis with compression fracture D7 to D11 vertebrae. Bone marrow aspiration confirmed the diagnosis of pre-B cell Acute Lymphoblastic Leukemia.

Why this article important?

The child presented to us with lower back pain, with difficulty walking. His general and clinical examination was unremarkable except for lumbar tenderness. The blood investigations including ESR were normal. The peripheral smear showed no evidence of leukemia. The Magnetic Resonance Imaging of the spine showed fracture from D7 to D11 vertebrae. Positron Emission tomography did not show any hot spots. The need to convince the parents for a painful bone marrow procedure in the absence of evidence through laboratory and imaging was quite a daunting task. The bone marrow examination clinched the diagnosis of Pre-B Cell Leukemia. The child is currently being treated in Pediatric Oncology for the same. This Case emphasizes ruling out common diseases with uncommon presentation

Summary of article

Osteoporosis is extremely rare in non-co-morbid children. Bone Mineral density is decreased in children with rheumatologic conditions, prolonged corticosteroid use as in Nephrotic Syndrome, and congenital diseases like Osteogenesis imperfecta. The 11-year-old patient presented to us with Lower Backache and tenderness. General and systemic examination was normal. The laboratory investigations including ESR and Peripheral smear within normal limits. MRI spine showed compression fracture D7 to D11 vertebra. His positron emission tomography did not show evidence of malignancy. The bone marrow examination clinched the diagnosis of Pre B Cell leukemia. This emphasizes the need to rule out occult disease even when all the laboratory investigations are within normal limits.

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