Low-Energy Multilevel Vertebral Fracture in a Pediatric Patient during Follow-up for Idiopathic Hypercalciuria: A Case Report

Compared to adult studies, there are a limited number of pediatric studies exploring the effects of hypercalciuria on bone mineral density.\udThe aim of this paper was to report a case of low-energy multilevel vertebral fracture in a pediatric patient during follow-up for idiopathic\udhypercalciuria (IH); it was also attempted to remind clinicians that IH-induced fractures may also occur in children. A 10-year-old male child\udpresented to our outpatient clinic with back pain after jumping off from a height of approximately 50 cm. History of the patient showed that\udthe patient had been followed-up for idiopathic hypercalciuria for 8 years and his father had renal stones and hypercalciuria. There was no\udabnormality on physical examination, with an exception for tenderness and limitation of movement in lower thoracic and lumbar vertebrae.\udComplete blood count and biochemical parameters were normal except for an elevated alkaline phosphatase level. Dorsal and lumbar lateral\udplain graphs showed compression fractures of T4, T6, T8, and L3 vertebrae, therefore, lumbar and dorsal vertebral magnetic resonance\udimaging (MRI), bone mineral densitometry (BMD), and vitamin D level measurement were ordered. MRI revealed acute compression\udfracture and medullary edema in L3; there were also chronic osteoporotic fractures in T4, T6, and T8. BMD showed a lumbar total Z score\udof -2.9 and the Vitamin D level was 13.7 ng/mL (10-24 ng/mL indicates moderate deficiency). A control renal ultrasonography revealed no\udkidney stones or calcification. The patient was prescribed polyethylene mold thoracolumbar corset and vitamin D support at a dose not to\udenhance hypercalciuria and nephrocalcinosis. His pain was alleviated at follow-up. Considering that most of the total bone mass is acquired\udat childhood, identification of causative factors and taking necessary measures at an early stage may prevent future complications of IH