A 25-year-old woman came to the Nutrition Service for monitoring her nutritional status; seven months before she had been diagnosed with Ulcerative Colitis (UC), and during this period she had received treatment with oral corticosteroids 1.5 mg descending IV methylpredni
She complained of arthralgias in both knees, and on physical examination she presented pain at posterior rotation in the two femoral heads, more evident on the right side, hip that also presented limited internal rotation; the left knee showed reduced movement
No markers of autoimmunity were detected in the analyses performed, and plasma concentrations of calcium, phosphorus and vitamin D were within the range of norniality.
Bone densitometry (BMD) showed osteoporosis in the lumbar spine (T score - 3.1) and osteosynthesis in the femoral neck (T score - 1.5).
Plain radiographs showed data suggestive of grade II NA in both femoral heads, more evident on the right side; on the knees an osteochondral lesion on the left internal femoral condyle was observed.
Magnetic resonance imaging confirmed necrosis lesions in both femoral heads and both knees, both on the tibial and femoral sides.
In the following MRI, performed only 3 months later, there was evidence of left hip sinking.
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The patient was treated with alendate and calcium and vitamin D supplements due to her osteoporosis, corticoids were suspended and the affected weight bearing was advised.
