Verification of osteoporotic vertebral fractures caused by glucocorticoids

Abstract

Long-term administration of glucocorticoids leads to rapid osteoporosis, and vertebral fractures are one of its most common complications. The methods used in identification are semi-quantitative ones, based on visual assessment, and quantitative ones, which use morphometric criteria. A 79-year-old woman, who has suffered from polymyalgia rheumatica since July 2012, was treated with prednisone at a daily dose of 20 mg. Radiography of thoracic and lumbar spine verified the reduction of body height of T 12, L3 and L4 vertebrae. Densitometry findings showed a decrease in bone density at the lumbar segment of the spine and femoral neck. Dual-energy x-ray absorptiometry device was used to perform vertebral morphometry by applying Genant semi-quantitative method, which verified crush fractures of the body of T4 and L3 vertebrae, while the L2 vertebra had a biconcave shape. The spinal deformity index parameter was 8. An intense pain developed in the back after 9 months of glucocorticoids administration. The repeated radiographic findings of thoracic and lumbar spine and vertebral morphometry, which had been done by dual-energy xray absorptiometry device, revealed deterioration in the form of serial crush fractures, while fat distribution index parameter increased to 15. Dual-energy x-ray absorptiometry finding showed a decrease in T score at the femoral neck. Long-term administration of glucocorticoids is accompanied by a rapid loss of bone mass, and vertebral fractures are one of its most common consequences. Therefore, its prevention, early diagnosis and treatment are required. The combination of qualitative conventional radiography and semi-quantitative dual-energy xray absorptiometry vertebral morphometry plays an important role in identifying vertebral fractures.