An evidence-based algorithmic approach to osteoporosis etiology verification on the example of a clinical case

Abstract

Background. The importance of timely detection of osteoporosis in patients is conditioned by its severe consequences such as osteoporotic fractures. The disease can be both primary and related to the existing other pathology or to the therapy being carried out, i.e. secondary. In young patients, in most cases, osteoporosis is secondary in nature. Diagnosis verification requires doctor’s perseverance and knowledge. Purpose – is to demonstrate an algorithm of finding a possible cause of the osteoporosis development in a young person on the example of a clinical case. Materials and Methods. The medical history of a 32-year-old man is presented. The man was consulted a doctor with complaints of long-lasting aching pain in the back, stiffness in the morning in the thoracic spine and pain during movement, and was diagnosed with a compression fracture of the spine on the background of a decrease in bone mineral density. Results. The article describes the step-by-step algorithm of making a diagnosis by gradually excluding primary osteoporosis and possible causes of the secondary nature of the disease. Information about the possible mechanisms of osteoporosis formation in the most common conditions included to the differential diagnosis is given in the article. The described diagnostic search algorithm can be used in the practice of a doctor of any specialty. Conclusions. Making a diagnosis of osteoporosis must include a differential diagnosis of its forms with the establishment of the ethiology of this pathology. In young patients, in most cases, osteoporosis has secondary nature and requires a mandatory search for its cause by gradually and methodically excluding conditions that can lead to a decrease in the mineral density of bone tissue, including genetic ones. In practice, there are cases of idiopathic osteoporosis, when the examination does not allow to clearly establish the reasons that led to a decrease in bone density. Such cases require the special attention of doctors, because the diagnosis of the main disease that led to the development of osteoporosis in the future can be detected. In this case along with antiresorptive drugs, therapy of the condition, which is the root cause of the development of osteoporosis, is prescribed, if possible. The specified combined therapy will contribute to increasing the effectiveness of treatment and shortening its duration.