1524 - Osteoporosis Secondary to Traumatic Brain Injury: A Noteworthy Consideration

Thursday, February 22, 2024

5:00 PM – 6:30 PM EDT

Presenting Author(s)

FW

Francis Walson, BS

Medical Student
USF Morsani College of Medicine
Tampa, Florida, United States

Co-Author(s)

JR

Jeffrey Radecki, MD

Chief, Division of Physical Medicine and Rehabilitation
Lehigh Valley Health Network
Bethlehem, Pennsylvania, United States

Case Diagnosis: Thoracic back pain due to traumatic T7 vertebra compression fracture

Case Description: Patient is a 39-year-old male with history of mild TBI in 2002, low vitamin D, and a nocturnal seizure one month ago who presented with right sided thoracic back pain. After the seizure, he began experiencing the pain and imaging in the ED showed acute T7 vertebral fracture. His exam was remarkable for isolated pain in the mid-thoracic region. DEXA scans confirmed osteoporosis in the lumbar spine. He was subsequently evaluated by rheumatology to rule out secondary causes for osteoporosis. These included parathyroid hormone level, thyroid levels, serum protein electrophoresis, 24-hour urine for calcium excretion, testosterone profiling. All studies were essentially normal.

Despite full 4 year treatment with Forteo, Fosamax, and vitamin D supplementation, he continues to endorse pain and his most recent DEXA in 2023 indicated no improvement in lumbar spine osteoporosis.

Discussions: Given that the patient lacks common risk factors for osteoporosis with a negative workup, it is essential to consider less common causes. With his history of mild TBI over 20 years ago and a seizure episode leading to the compression fracture, his osteoporosis may be related to the long-term sequela of the TBI.

Increasing literature suggests neuroendocrine changes with TBI, thereby increasing osteoporosis risk. However, there is sparse literature evaluating bone mineral density of the spine and TBI history, as many studies depict osteoporotic changes in the femur and a dysregulated parathyroid and vitamin D axis. However, this case uniquely suggests this potential link.

Conclusions: One must consider history of TBI as a possible etiology in patients complaining of back pain and osteoporosis without typical risk factors. This case warrants further investigation into this relationship, especially since osteoporosis can cause asymptomatic bone deterioration and ultimately fractures.