Bone mineral density in hypoparathyoidism: Not a useful tool (a case in point)

Hypoparathyroidism is a rare condition associating autoimmune, genetic, post-operatory (most frequent) or idiopathic causes. Low calcium causes neuromuscular irritability of chronic or acute type like muscle crample, paresthesia, tingling, cardiac rhythm anomalies, seizures, etc. Despite calcium and active vitamin D replacement, acute complications are frequently seen and generally a reduced quality of life is registered since pathogenic medication like parathormone drug substitution is not currently available in daily practice. Other complications are due to overtreatment with calcium and vitamin D like kidney stones and associated urinary infections and hypercalciuria while increased calcium-phosphor product causes calcifilaxia of different locations causing complications like skin necrosis, brain calcifications with seizures, etc. We introduce a case of hypoparathyoidism in association with other co- morbiditis and a brief discussion around the case related to bone mineral density anomalies or usefulness in general panel of investigations in this particular topic. This is a 43-year old non-smoking male coming from non-endemic area that had a small lesion of skin necrosis at left hand. He has autoimmune thyroiditis and on admission low values of calcium and PTH 2 pg/ml (normal 15-65 pg/ml) are consistent for the diagnosis of hypoparathyroidsm, probably of autoimmune cause. Central DXA shows high BMD at each site. He was offered calcium and vitamin D replacements with a mild clinical improvement. This case of autoimmune hypoparathyroidism associated with Hashimoto’s thyroiditis highlights the idea of high DXA-BMD due to cortical and trabecular effects of PTH deficiency.