Fractures due to severe generalised osteoporosis in a 44-year-old male with diabetes mellitus.

A 44-year-old Chinese male with a 7-year history of diabetes developed spontaneous fractures affecting the femur and distal tibia and fibula within a period of 4 months. Spontaneous rib fractures were also present. There was additional evidence of extensive tissue damage with retinopathy, proteinuria, necrobiosis lipoidica diabeticorum, peripheral neuropathy and autonomic neuropathy. Investigation confirmed the presence of generalised osteoporosis and showed no evidence of other metabolic bone disease or abnormal vitamin D metabolism. Mild hypogonadism was also present and investigation suggested a disturbance of hypothalamic-pituitary control of gonadal function. It is suggested that the severe generalised osteoporosis resulted from poorly controlled diabetes with a possible additional contribution from androgen deficiency secondary to the diabetes.