An Athletic Teen Suddenly Prone to Falls and Fractures

Inas H. Thomas, MD


June 06, 2022

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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).

Figure 1.

Figure 2.

Figure 3.

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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