Case ReportNontraumatic Multiple Vertebral Compression Fractures Induced by Primary Hyperparathyroidism: A Case Report and Literature Review
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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Cited by (2)
Vertebral fractures cascade: potential causes and risk factors
2019, Osteoporosis International
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.