SYNOPSIS: Male hypogonadi sm i s an impor tant and treatable cause of osteoporosis. Severe osteoporosis leading to multiple osteoporotic fractures from idiopathic hypogonadotrophic hypogonadism (IHH) is rare. The present case illustrates the significance of timely and thorough evaluation of young adult males presenting with a seemingly ordinary complaint of "bone pains."
THE CASE: I report a case of a 45 year-old male presenting with a 6-year history of progressive bone pains. Most prominent laboratory findings include low total serum tes tos terone (4.6 nmol/L) in the background of an inappropriately normal serum FSH, LH and sex hormonebinding globulin (SHBG). There is associated elevated urinary N- telopeptide (4x). Sperm analysis showed oligospermia. Scrotal ultrasound revealed normal-sized descended testis with no solid masses. Skeletal survey showed generalized decrease in bone density. Dual energy x-ray absortiometry (DXA) showed severe osteoporosis. Cranial CT scan with contrast did not show a sellar-suprasellar mass.
TREATMENT AND OUTCOME: The patient was diagnosed with severe osteoporosis secondary to IHH. The patient received zoledronic acid (Aclasta) 5mg IV infusion. Two months after discharge, the patient reports a significant decrease in bone pains leading to more mobility. He is scheduled for his first dose of a GnRH agonist (Leuprodin acetate 3.75mg IM) to induce testosterone production.
DISCUSSIONS: The incidence of osteoporosis among males is indirectly correlated to the reduction in circulating testosterone. First - line t reatment of os teoporosis in hypogonadal men is with bisphosphonates. Bisphosphanate therapy increase BMD, reduces vertebral fracture risk and is currently considered the standard of care for osteoporotic care for men.
CONCLUSION: Osteoporosis is fast becoming a common condition among males. Osteoporotic fractures are associated with substantial morbidity and mortality. The present case emphasizes the importance of thorough and timely evaluation among men with low BMD or low-trauma fractures, which should include laboratory assessment to exclude secondary causes such as hypogonadism.