Juvenile osteoporosis in a 5-year-old girl
A 5-year-old girl born of nonconsanguineous marriage presented with nonprogressive chest deformity since birth. A physician had done X-ray of spine that showed osteopenic bones with cod-fish appearance of spine and kyphosis without signs of rickets and had referred the patient to us. There were no fractures. Child had an elder sister of 6½ years of age who was normal. The patient had no other deformities and milestones were normal. She was on regular balanced diet. On examination, she had kyphosis and hunchback. Other systems were normal. Investigations showed serum calcium of 9.8 mg/dL, phosphorus of 4.8 mg/dL, and alkaline phosphatase of 1431 IU/L. Her serial calcium, phosphorus, and alkaline phosphatase are depicted in . Her urine calcium/creatinine was 0.46. Blood gas analysis showed no acidosis (pH 7.36, bicarbonate = 21.7) with ultrasound kidneys being normal and creatinine of 0.5 mg/dL. Bone mineral density (BMD) showed severe osteoporosis []. She was treated with oral calcium carbonate (50 mg/kg/day) and oral alendronate (0.5 mg/kg/day) for 9 months. Her 25 hydroxy Vitamin D levels at end of 6 months of therapy were 24 ng/mL (normal = 9-37.6 ng/mL) and serum parathyroid hormones were 27.9 pg/mL (normal = 12-95 pg/mL). Her deformity and BMD [] gradually improved and she had no adverse effects to alendronate.