Question

A 13 y/o male was diagnosed with rheumatoid arthritis at the age of 7. While the disease has progressed, the pain and swelling associated with it was controlled with treatment. However, he has continually been teased by his classmates for his “fat” appearance and recently has been experiencing multiple fractures. A bone density scan (DEXA) found that his T scores were 2.5 standard deviations below the mean for his age group.

What is your diagnosis?

How would you test your diagnosis?

Answer 1

The possible diagnosis for this condition is Juvenile osteoporosis(secondary)

This patient diagnoses with rheumatoid arthritis at the age of 7. He had been under treatment for the same, especially for pain and swelling. Normally corticosteroids are given for rheumatoid arthritis as an anti-inflammatory to reduce pain and swelling. Prolonged use of this corticosteroid results in obesity. Pain on joints may restrict physical activities, which is necessary for building and maintaining bone mass further leads to weakness and further fracture of bones.

A bone density scan (DEXA) of T scores 2.5 standard deviations below the mean for his age group indicates osteoporosis.

Confirmatory diagnosis of osteoporosis is by testing bone density scan.