Elsevier

World Neurosurgery

Volume 108, December 2017, Pages 992.e5-992.e9
World Neurosurgery

Case Report
Nontraumatic Multiple Vertebral Compression Fractures Induced by Primary Hyperparathyroidism: A Case Report and Literature Review

https://doi.org/10.1016/j.wneu.2017.08.157Get rights and content

Background

Primary hyperparathyroidism (PHPT) is one of the causes of osteoporosis and is known to increase the fracture risk of bone. However, multiple vertebral compression fracture because of PHPT is extremely rare.

Case Description

A case of acute multiple vertebral compression fracture in a patient with PHPT is described. The fracture occurred suddenly without trauma. The patient had a low T score (−4.4), and serum hypercalcemia and phosphatemia were evident. On examination, serum parathyroid hormone was found to be elevated, and PHPT was diagnosed by neck sonography and technetium-99m methoxyisobutylisonitrile scan. Once the patient was diagnosed with PHPT, we performed subtotal parathyroidectomy and corrective spinal surgery for multiple compression fractures.

Conclusions

When a patient has multiple compression fractures without any trauma history and a very low T score, the presence of other underlying diseases should be investigated.

Introduction

Senile osteoporotic vertebral compression fracture is very commonly encountered in older adults. Approximately 700,000 osteoporosis-related vertebral fractures occur in the United States each year.1

Primary hyperparathyroidism (PHPT) is an important alternate cause of osteoporosis. This disease is frequently seen in clinical practice and is known to increase the fracture risk of bone, especially vertebra and femur neck fractures.2

Parathyroid hormone (PTH) is the primary regulator of calcium levels in the extracellular fluid and acts to increase blood calcium levels and decrease blood phosphate concentration.3 The effects of PTH on bone vary, but continuous exposure of bone to PTH stimulates osteoclast action. Ultimately, bone resorption is increased and osteoporosis develops. Khosla et al.4 found that the risk of vertebral compression fracture was significantly increased (by >3-fold) in patients with PHPT. However, nontraumatic multiple vertebral compression fracture induced by PHPT is extremely rare. Here, we report a case of spontaneous fracture in a patient with PHPT.

Section snippets

Case Description

A 59-year-old woman visited our outpatient clinic complaining of lower back pain, and had undergone caudal blockage and conservative treatment (rest and use of nonsteroidal anti-inflammatory drugs). Her medical history only included a prescription for an antihypertension drug. At that time, lumbar radiology revealed multiple disk degenerative changes and mild disk herniation, but no vertebral compression fracture (Figure 1). She revisited our clinic after 6 months as per our follow-up schedule,

Discussion

PTH acts acutely to promote calcium release from bone. A chronic effect of the hormone is promotion of bone remodeling by activating both osteoclasts and osteoblasts.3, 5 Under such conditions, the bone mineral density of trabecular bone is relatively well preserved, whereas the bone mineral density of cortical bones is not.6

PHPT is a disease characterized by autonomous production of PTH, which results in high serum calcium with elevated serum PTH.7 Although the topic remains controversial,

Conclusions

Sudden and multiple vertebral compression fractures without any obvious trauma are rare. When these conditions are accompanied by a very low T score, compared with that of age- and sex-matched subjects, it is necessary to consider whether another pathologic condition is present so that the underlying disease can be treated first.

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Conflict of interest statement: The authors declare that the article content was composed in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

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