From dermatomyositis to osteoporosis

Abstract

Our aim is to describe a case of a menopausal woman who started with dermatomyositis and then became a patient at endocrinology because of complicated glucocorticoid osteoporosis. This is a 63-year old female who suddenly started to accuse intense muscle pain associated with redness of the skin. She was confirmed with dermatomyositis and offered high doses of oral metilprednisolone. The thyroid ultrasound showed micronodular background and a small nodule of 0.7 cm without clinical relevance with an increase of antibodies thyroperoxidase antibody and normal thyroid function. Bone turnover markers were within normal in addition to decrease of serum 25-hydroxyvitamin D of 20 ng/ml. DXA (Dual-Energy X-Ray Absorptiometry) showed ostepenia based on a minimum T-score of-2.4 SD. The patient was offered high doses of cholecalciferol 2,000 UI per day and 500 mg of calcium daily in addition to weekly alendronate due to the high risk of fracture because of the glucocorticoid doses. 6 months later she suffered and accidental fall and a hip fracture was confirmed and required surgery. Further on the therapy was switched to zolendronic acid one injection per year. The dermatological and muscle progressively improved thus the doses of corticoids were reduced. As particular observation the presence of autoimmune thyroid condition may increase the risk of a second autoimmune disease like dermatomyositis, also the specific antibodies panel was negative. A multidisciplinary team needs to be involved in associated therapy for dermatomyositis and complications of glucocorticoids use.