Severe Osteoporosis with Fragility Fracture Revealing Primary Hyperparathyroidism
https://doi.org/10.15605/jafes.041.S1
- Author:
Sarojini Devi Simanchalam
1
;
Poh Shean Wong
1
;
Nor Afidah Abdul Karim
1
;
Noor Lita Adam
1
;
Fauzi Azizan
2
Author Information
1. Department of Medicine and Endocrinology, Hospital Tuanku Jaafar
2. Department of Medicine, Hospital Tuanku Ampuan Najihah
- Publication Type:Journal Article
- MeSH:
Hyperparathyroidism, Primary;
Osteoporosis
- From:
Journal of the ASEAN Federation of Endocrine Societies
2026;41(S1):73-
- CountryPhilippines
- Language:English
-
Abstract:
Introduction:Primary hyperparathyroidism (PHPT) is frequently asymptomatic or detected incidentally; however, delayed diagnosis may lead to severe skeletal complications. Early recognition is essential, as timely identification and management
of parathyroid disease can prevent significant morbidity,
although diagnosis may be challenging when clinical and
imaging findings are inconclusive.
Case:A 46-year-old female with severe bilateral hearing impairment presented to the orthopedic clinic with 3 years’ history
of bilateral knee pain and was found to have a right intertrochanteric femur fracture following minimal trauma.
She was referred for evaluation of suspected secondary
osteoporosis. She has had intermittent constipation and
long-standing oligomenorrhea since menarche. There was
no history of childhood fractures or use of medications
affecting bone metabolism. Examination revealed bilateral
knee bowing.
Initial evaluation considered metabolic bone disease, including Paget’s disease; however, skeletal survey showed no
features suggestive of Paget’s disease or multiple myeloma.
Biochemical investigations demonstrated persistent
hypercalcemia (2.65–3.1 mmol/L) with inappropriately
elevated intact parathyroid hormone (peak 7.62 pmol/L),
consistent with PHPT. Serum phosphate was low-normal.
Concomitant vitamin D deficiency (25-OH vitamin D
34.46 nmol/L) improved following replacement. Bone
mineral density confirmed severe osteoporosis (lumbar
spine T-score −5, z-score -4.1); (forearm −6.7, z-score -6.1)
reflecting prolonged untreated disease.
Neck ultrasound demonstrated a mixed solid-cystic
lesion posterior to the right thyroid lobe, suggestive of a
parathyroid adenoma. The TC-99 m Sestamibi scan showed
no definite focal uptake. However, subsequent SPECT-CT
revealed focal tracer uptake at the posterior right thyroid
gland, consistent with a hyperfunctioning parathyroid
gland. Parathyroidectomy was done. Postoperatively, the
calcium level normalized.
Conclusion:Severe osteoporosis and fragility fracture occur, reflecting
prolonged exposure to excess parathyroid hormone and
significant skeletal morbidity. Early biochemical evaluation
in unexplained severe osteoporosis is essential, as timely
diagnosis and definitive management of parathyroid
disease are critical to halt ongoing bone loss and prevent
irreversible complications.
- Full text:2026080410412031133EP_A097.pdf
