The Case Challenge series includes difficult-to-diagnose conditions, some of which are not frequently encountered by most clinicians but are nonetheless important to accurately recognize. Test your diagnostic and treatment skills using the following patient scenario and corresponding questions. If you have a case you would like to suggest for a future Case Challenge, please contact us.
A 14-year-old athletic boy with type 1 diabetes and Hashimoto thyroiditis has had four fractures over the past 2 years. He had two sternum fractures from playing basketball (Figure 1) and two separate falls that led to a thumb (Figure 2) and radius (Figure 3) fracture. He also has had a scaphoid injury (Figure 4).
The injuries all had trauma associated with them; however, his mother points out that the injuries were more common in her son than among his teammates, who also have similar activity levels. The mother also has a question about an outside radiology report that states "osteopenia is noted." He does not have a history of previous injuries or fractures and does not easily bruise.
His type 1 diabetes, which was diagnosed at age 10 years, is poorly controlled, with A1c in the 9%-10% range. He has positive thyroid peroxidase antibodies but has not developed acquired hypothyroidism yet. Medications include insulin via insulin pump, antacids at 750 mg daily, and vitamin D at 1000 international units (IU) daily (started 3 years prior due to a vitamin D level of 23 ng/mL [reference range, 25-100 ng/mL]). His vision is checked as part of his annual examinations for diabetes and is unremarkable.
His family history includes a mother with Hashimoto thyroiditis and a grandmother with osteoporosis diagnosed in her 60s. No family history of genetic disorders or other autoimmune diseases is noted.
A review of systems is negative for hearing abnormalities, diarrhea, or developmental delay. He denies increased joint flexibility or skin laxity.
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Cite this: Inas H. Thomas. An Athletic Teen Suddenly Prone to Falls and Fractures - Medscape - Jun 06, 2022.