Abstract
Osteoporotic vertebral fractures usually heal with kyphotic deformities with subsidence of the vertebral body when treated conservatively. Corrective vertebral union using only antiosteoporotic pharmacotherapy without surgical intervention has not been reported previously. An 81-year-old female with osteoporosis presented with symptomatic fresh L1 vertebral fracture with intravertebral cleft. Segmental vertebral kyphosis angle (VKA) at L1 was 20° at diagnosis. Once-weekly teriparatide administration, hospitalized rest, and application of a thoracolumbosacral orthosis alleviated symptoms within 2 months. Corrective union of the affected vertebra was obtained with these treatments. VKA at 2 months after injury was 8° (correction, 12°) and was maintained as of the latest follow-up at 7 months. Teriparatide has potent bone-forming effects and has thus been expected to enhance fracture healing. Based on the clinical experience of this case, teriparatide may have the potential to allow correction of unstable vertebral fractures without surgical intervention.
Highlights
Vertebral fractures are the most common fragility fractures in patients with osteoporosis [1]
We recently encountered a patient with severe osteoporosis in whom osteoporotic vertebral fracture was correctively healed with only teriparatide administration and hospitalization, with no need for surgical intervention
The natural history of osteoporotic vertebral fractures usually leads to spontaneous consolidation of the deformed vertebral body, but in some cases instability remains after fracture and can be a cause of persistent pain [5]
Summary
Vertebral fractures are the most common fragility fractures in patients with osteoporosis [1]. Osteoporotic vertebral fractures usually heal with kyphotic deformities resulting from subsidence of the vertebral body when treated conservatively [2, 3]. To maintain vertebral height and prevent angulation, surgical treatments including kyphoplasties are indicated [4, 5]. We recently encountered a patient with severe osteoporosis in whom osteoporotic vertebral fracture was correctively healed with only teriparatide administration and hospitalization, with no need for surgical intervention. We describe our clinical experience with this patient. To the best of our knowledge, corrective vertebral union using antiosteoporotic pharmacotherapy without surgical intervention has not been reported previously in the English literature
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