A 41-year-old man with a vertebral fracture and bone marrow mastocytosis.

A 41-years-old male patient from Greece was referred to our unit for metabolic and dietary consultation. He was overweight (BMI 30.2 kgr/m), with a recent history of a vertebral fracture (L1) 50 days ago (Figure 1), and he was instructed to lose weight as part of a conservative approach for his fracture. His past medical history was unremarkable, however the vertebral fracture resulted from a fainting episode during a hot shower following intense exercise at the gym. No neurological or cardiological problems were detected from the initial evaluation of the fainting episode. We were unable to define whether this was a low or a high energy fracture, thus his bone mineral density (BMD) was evaluated by dual X-Ray absorptiometry (DXA) equipment (Lunar, Lunar Corporation, Madison, USA) which uses an Italian male reference population. A BMD below the expected range for age was found in the lumbar spine (L2-L4: 1.101 g/cm, Z score:-2.82) but not in his non-dominant femoral neck (1.001 g/cm, Z score:-0.79). Laboratory investigation was consequently performed for secondary osteoporosis (Table 1). Although no clinical manifestations of mastocytosis were either reported or observed, serum tryptase was found elevated, as well as 24h urine N-methyl istamine (Table 1). Bone marrow biopsy revealed multifocal infiltration of abnormal mast cells (>15 mast cells per aggregate) which in addition with the serum tryptase level of >20 ng/mL confirmed the diagnosis of systemic mastocytosis (SM). A skeletal survey revealed no other skeletal involvement. The patient reported J Musculoskelet Neuronal Interact 2010; 10(4):290-292