We report a 30-year-old woman who presented during pregnancy with mechanical type backache due to non-traumatic multiple vertebral fractures. In-depth the assessment revealed multiple risk factors for osteoporosis, including adolescent steroid use for asthma, prolonged breastfeeding, and vitamin D deficiency. She also had persistently elevated inflammatory markers with radiological evidence of early inflammatory Sacro-ileitis. The rheumatoid factor and HLA B27 were negative. She was successfully managed with NSAIDS, zoledronic acid, and calcium supplementation. This is an example of early inflammatory arthritis in the background of multiple risk factors causing osteoporosis severe enough to cause fragility fractures. This signifies the importance of screening for multiple risk factors in pre-menopausal osteoporosis even in the presence of one or two identified risk factors.
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