A 47-year-old man presented with multiple vertebral fractures without identifiable trauma (L1, L2 and L4).
DXA showed DMO in L2-L4 of 0.896 g/cm2 (Z score-2.6) and 0.795 g/cm2 (Z score-1.5) in femoral neck.
The anamnesis only highlighted smoking 10 cigarettes/day with intake of 2 dairy units/day.
The study of secondary causes was negative.
An idiopathic male osteoporosis was proposed.
The patient was managed with optimization of dairy intake and vitamin D plus alendronate 70 mg weekly.
The control with DXA one year after treatment showed presence of DMO in the lumbar spine with a 6% increase in the femoral neck.
Three years later, MRI showed new fractures in L4 and L5.
A secondary cause study was repeated, adding this time serum tryptase measurement that resulted in 42.6 ng/ml.
The patient had no clinical signs or symptoms of SD.
The diagnosis was confirmed with OM biopsy.
Osteoporosis secondary to SD was diagnosed. Denosumab 60 mg s.c. was initiated every 6 months and sent to Hematology and Immunology for management of SD.
