|previous article in this issue||next article in this issue|
Document Details :
Title: Een ongewone spontane wervelbreuk
Author(s): MANIEWSKI U, VAN OFFEL J, GIELEN J, DE CLERCK L
Journal: Tijdschrift voor Geneeskunde
Volume: 67 Issue: 17 Date: 2011
An unusual vertebral fracture
Vitamin D deficiency is common in the general population and in postmenopausal women in particular. Classical postmenopausal osteoporosis is characterised by an increased fracture risk of the hip, distal radius or vertebrae. In the latter the most common radiologic presentation is a wedge or a fishbone aspect of the vertebrae. Vitamin D deficiency constitutes an additional risk factor for fractures because of an impaired mineralization of the bone and an increased risk of falls due to muscle weakness. We present the clinical history of an extreme obese postmenopausal 74-year-old woman who presented with a spontaneous burst fracture of L1 proven on X-ray and CT scan, probably caused by a vitamin D deficiency.
Burst fractures are a rare presentation of classical osteoporosis and they usually occur after an axial trauma which did not happen in this patient. Bone strength was probably impaired due to the vitamin D deficiency, whereas extreme obesitas could have contributed to this spontaneous fracture. Furthermore, we suppose healing of this fracture is compromised as axial pressure due to obesitas might promote separation of bone fragments.
In this case calcium and vitamin D substitution was started together with calcitonin. A few months later her pain improved and four months after her first consultation minimal callus was visible on RX of the lumbar vertebrae. Her mobility did slightly improve.