The Effect of Percutaneous Vertebroplasty in Glucocorticoid Induced Osteoporotic Vertebral Compression Fractures: A Case Report
Jae Hyung Ryu *
Department of Anesthesiology and Pain Medicine, Korea University Guro Hospital, Korea University College of Medicine, Gurodong-ro 148, Guro-gu, Seoul-08308, Republic of Korea.
Yu Jin Kim
Department of Anesthesiology and Pain Medicine, Korea University Guro Hospital, Korea University College of Medicine, Gurodong-ro 148, Guro-gu, Seoul-08308, Republic of Korea.
Sang Sik Choi
Department of Anesthesiology and Pain Medicine, Korea University Guro Hospital, Korea University College of Medicine, Gurodong-ro 148, Guro-gu, Seoul-08308, Republic of Korea.
*Author to whom correspondence should be addressed.
Abstract
A 73-year-old woman with secondary adrenal insufficiency, who discontinued denosumab injection 9 months ago, presented with severe back pain. She was already diagnosed with an acute L1 compression fracture refractory to a month-long conservative treatment. Consequently, L1 percutaneous vertebroplasty (PVP) was performed, but the patient continued to complain of persistent lower back pain. Subsequent magnetic resonance imaging (MRI) revealed acute compression fractures at L2 and L5 vertebral body. After additional PVPs at L2 and L5, the patient experienced a dramatic reduction in pain. However, three weeks later, a new compression fracture occurred at L3, and she is currently undergoing conservative treatment. Percutaneous vertebral augmentation (PVA) is a safe and immediately effective treatment for glucocorticoid-induced osteoporosis (GIOP)-related osteoporotic vertebral compression fracture (OVCF) when pain is not controlled by conservative treatment. Abrupt discontinuation of prolonged Denosumab treatment can lead to rebound fractures; therefore, transitioning appropriately according to guidelines is recommended.
Keywords: Percutaneous vertebroplasty, osteoporotic vertebral compression fractures, secondary adrenal insufficiency, glucocorticoid-induced osteoporosis, discontinuation of denosumab, rebound fractures