A 37-year-old patient was initially presented to his primary care physician with complaints of lumbago and diffuse arthralgias. There was no significant past medical history in this case. X-ray examination An X-ray of L-spine of this patient was concerning for decreased bone mass and a DEXA scan was notable for a Z-score of −3.6. Physical examination On physical examination, an intact neurologic function was revealed.
Secondary workup was significant for normal renal and liver function. Celiac disease, multiple myelomas, and glucocorticoid excess were excluded with tissue transglutaminase and anti-endomysial antibodies, SPEP/UPEP, and 24-hour urine cortisol and dexamethasone suppression test, respectively. Additional evaluation An endocrinologic evaluation revealed normal thyroid function in this case. Patient’s calcium and phosphorus were normal, while he was noted to be vitamin D…
