A Silent Complication of Prolonged Immobilization: Fragility Fracture in a Chronically Ill Adolescent with Thalassemia
https://doi.org/10.15605/jafes.041.S1
- Author:
Saw Shi Hui
1
Author Information
1. Hospital Raja Permaisuri Bainun
- Publication Type:Journal Article
- MeSH:
Adolescent;
Humans;
Chronic Disease;
Thalassemia
- From:
Journal of the ASEAN Federation of Endocrine Societies
2026;41(S1):140-
- CountryPhilippines
- Language:English
-
Abstract:
Introduction:Adolescence is a crucial period for achieving peak bone
mass. Risk factors such as chronic inflammation, endocrine
issues, corticosteroid use, and extended immobility can lead
to severe secondary osteoporosis and fragility fractures.
Case:A 15-year-old female with transfusion-dependent thalassemia had been hospitalized for over a year following
severe acute gastroenteritis complicated by septic shock,
multiorgan failure, and secondary hemophagocytic lymphohistiocytosis (HLH). She received pulse methylprednisolone
therapy for HLH, which was tapered over 6 months. Her
clinical course was further complicated by critical illness
polyneuropathy and post-infectious bronchiectasis, leading
to ventilator dependence and a bedbound state.
During regular physiotherapy sessions, she developed a
sudden onset of severe left shoulder pain. A radiograph of
the left shoulder revealed a closed fracture of the humeral
neck.
Biochemical evaluation showed normal serum calcium and
phosphate levels, adequate vitamin D status, and normal
alkaline phosphatase levels. However, follicle-stimulating
hormone, luteinizing hormone (LH), and estradiol levels
were undetectable, consistent with arrested puberty due
to chronic illness. A bone mineral density scan showed a
lumbar spine Z-score of −6, indicating severe osteoporosis.
She was started on intravenous zoledronate for secondary
osteoporosis, and physiotherapy was resumed to improve
musculoskeletal strength.
Conclusion:This patient was treated with bisphosphonate therapy for
severe secondary osteoporosis caused by multiple risk
factors, including chronic illness, prolonged immobility,
corticosteroid use, and hypogonadotropic hypogonadism,
with limited potential for spontaneous bone recovery.
This case highlights the importance of early endocrine
monitoring and bone health assessments to identify
impaired bone growth and prevent fragility fractures in
high-risk adolescents.
- Full text:2026081013331208893EP_P011.pdf
