Tibial Fracture in an Elderly Female Patient of Rheumatoid Arthritis: A Preventable Iatrogenic Injury

Abstract

Oral systemic glucocorticoids widely used in the medical practice to treat various diseases like asthma, systemic connective tissue diseases, other autoimmune diseases and in transplantology, are considered the main cause of secondary and iatrogenic osteoporosis. The pathogenesis of glucocorticoid induced bone loss is multifactorial and complex. The exact mechanism remains undefined. The present report describes a case of 65 yr old female presenting with fracture in mid shaft of tibia after a very low velocity trauma. On medical history elicitation, she was found to be treated for rheumatoid arthritis with oral glucocorticoids. Causality, severity and preventability assessment was done for the reaction. Potentiality of glucocorticoids causing fractures is often neglected by professionals and ignored by patient and their caregivers. Given the potential for rapid bone loss with glucocorticoid therapy, frequent monitoring is warranted while bearing in mind that BMD is a surrogate marker for fracture risk and patients on glucocorticoids fracture at higher BMD than other patients. Once treatment is initiated, BMD should be monitored annually to ensure compliance and efficacy.