Postpartum Vertebral Fracture Due to Osteomalacia

Year 2012, Volume: 4 Issue: 1, 37 - 38, 01.04.2012

Betül Toygar Nurdan Kotevoğlu Hayal Ahmetoğlu

Abstract

Twenty-seven years old woman complaining of severe back pain beginning after giving birth to a baby seven months ago with increase in her complaint for last four months.She had difficulty in standing in erect position and feel much more severe pain. She had no trauma and still on lactation. Physical examination revealed a kyphotic posture with minimal flexion and extension limitation but severe pain. Toracal 8,9,10th vertebrae were tender on palpation. She did not have any neurological sign. MRI examination showed severe vertebral compression on dorsal 8,9,11,12 vertebrae. BMD results were as follows: L1:- 2.6, L2:-3.2, L3:-2.9, L4:-3.3, Femur neck -2.3. She had low 25-hydroxivitamin D level as 10.3 ng /ml with serum calcium10.2 mg and parathormon 83 pg/ml .She was diagnosed as osteomalasia triggered by pregnancy and her medical therapy was arrenged accordingly.

Keywords

Osteomalacia, vertebral fracture, Pregnancy

Gebelik Sonrası Osteomalasiye Bağlı Vertebral Fraktür

Abstract

Yirmiyedi yaşında bayan hasta şiddetli sırt ağrısı şikayeti ile başvurdu. 7 ay önce doğum yapan hastanın doğum sonrası başlayan sırt ağrıları son 4 aydır çok şiddetlenmişti. Hasta ayakta dik durunca zorlanıyor ve daha çok ağrı duyuyordu. Travma öyküsü yoktu ve halen bebeğini emziriyordu. Fizik muayenesinde kifotik duruş +, torakal bölgede fleksiyon ve ekstansiyon çok ağrılı , minimal kısıtlı, presyonla torakal 8,9, 10 . vertebralar şiddetli hassas bulundu. Nörolojik defisit bulunmayan hastanın torakal MRI tetkiklerinde T8,T9,T11,T12 vertebralarda belirgin yükseklik kaybı , torakal kifoz bulguları saptanması üzerine hastanın dansitometrik ölçümleri ve kan tetkikleri istendi. DEXA ile yapı- lan ölçümde t skorları L1. -2,6, L2: -3,2, L3:-2,9, L4:-3,3 femur boynu: -2,3 olarak saptandı . Kan tetkiklerinde 25 hidroksivit D: 10,3 Ca: 10,2, parathormon : 83 pg/ml olan hastada gebeliğin tetiklediği osteomalaziye bağlı torakal vetrebra fraktürü tanısı konularak tedavisi başlandı.

Keywords

Osteomalasi, vertebra fraktürü, gebelik

References

• 1. Prentice A.Am J Clin Nutr 2000;71( suppl ):1312S1316S.
• 2. Drinkwater BL,Chesnut CH.Bone density changes during pregnancy and lactation in women: a longitudinal study:Bone Miner 1991; 14:153-160.
• 3. Ostgaard HC, Andersson GBC, Wennergren M. The impact of low back pain and pelvic pain in pregnancy outcomes.Acta Obster Gynecol Scand 1991;70:21- 24.
• 4. Bjollund K, Naessen T, Nordstrom ML, Bergstorm S.Pregnency –related back and pelvic pain and changes in bone density.Acta Obstet Gynecol Scand 1999;7:681-685.
• 5. To WWK,Wong MWN.Factors associated with back pain symtoms in pregnancy and the persisitance of pain 2 years after pregnancy.Acta Obstet Gynecol Scand 2003;82:1086-1091.
• 6. Obstgaard HC, Zethertrom G, Ross-Hansson E. Back pain in relation to pregnancy : a 6 year follow-up.Spine 1997; 15:2945-2950.
• 7. To WWK,Wong MWN.Persistance of back pain sympoms after pregnancy and bone mineral density changes as measured by quantitative ultrasound- a two year longitudinal follow up study. Musculoskeletal Disorders 2011;12:55:1-7.
• 8. Ofluoglu O,Ofluoglu D. A case report: pregnancy induced severe osteoporosis with eight vertebral fractures.Rheumatol Int 2008:29;197-201.
• 9. Cooper C.Epidemiology and public helath impact of osteoporosis.Bailliere Clin Rheumatol Osteoporosis 1993: 7:459-477.
• 10. Espeland A, Korsbrekke K, Albrektsen G, Larsen JL. Observer variation n plain radiology of he lumbosacral spine. Br J Radiiol 1998: 71;366-375.
• 11. Sowers MF, Corton G, Shapiro B..Changes in bone density with lactation. JAMA 1993; 269:3130-3135
• 12. Pudie DW, Aaron JE, Selby P,. Bone histology andmineral homeostasis in human pregnancy.Br J Osbtet Gynaecol 1988;95:849-854.
• 13. Cross NA, Hillman LS, Allen AH,Krause GF, Vieira NE. Calcium homeostasis and bone matabolism during pregnancy ,lactation and postweaning: a longitudinal study.Am J Clin Nutr 1995;61:514-523.
• 14. Kent GN, Price RI, Gutteridge DH,. The efficiancy of intestinal calcium absorbtion is increased in late pregnancy but not in established lactation. Calcif Tissue Int 1991;48:293-295.