Glucocorticoid Induced Compression Fractures in a Patient with Pemphigus Vulgaris

Yıl 2007, Cilt: 12 Sayı: 4, 297 - 299, 01.08.2007

Emel Sabaz Günseli Karaca Arefe Yıldırım Salih Özgöçmen

Öz

Osteoporosis is recognized as primary or secondary related to various factors. Herein we presented a patient who developed osteoporosis and compression fractures related to high dose steroid treatment. Sixty-three years old female patient attended to our outpatient clinic with complaints of back and low back pain, and she had a history of high dose steroids for the treatment of pemphigus vulgaris. She had multiple compression fractures of the thoracic vertebrae. Bone mineral density revealed a T score of -2.3 for lumbar and -1.6 for femoral neck regions. Upon examination compression fractures were considered to be related to high dose glucocorticoid treatment. As a consequence; osteoporosis should not be overlooked in established and high dose corticosteroid treatment particularly in postmenopausal female and patients should be screened for osteoporosis prior to treatment and prophylaxis should be maintained if necessary. ©2007, Fırat University, Medical Faculty

Anahtar Kelimeler

-

Pemfigus Vulgaris Hastasında Glukokortikoid Kullanımına Bağlı Oluşan Kompresyon Fraktürleri

Öz

Osteoporoz, primer ve pek çok ikincil sebeplerle oluşan sekonder osteoporoz olarak ayrılabilir. Burada yüksek doz steroid kullanımı sonucu osteoporoz ve kompresyon fraktürleri gelişmiş bir hastayı sunmaktayız. Altmış üç yaşında kadın hasta polikliniğimize sırt ve bel ağrısı şikayeti ile başvurdu. Hastada pemfigus vulgaris nedeniyle yüksek doz steroid kullanma öyküsü mevcuttu. Çekilen grafisinde torakal bölgede multipl kompresyon fraktürleri mevcuttu. Çekilen kemik dansitometrisinde L2-4 vertebra T skoru -2.3, total femur T skoru -1.6 olarak saptandı. Olgu değerlendirildiğinde oluşan osteoporoz ve kompresyon fraktürlerinin kronik yüksek doz steroid kullanımına bağlı olabileceği düşünüldü. Burada uzun dönem steroid kullanması gereken hastalarda sekonder osteoporozun göz ardı edilmemesi gerektiği; özellikle postmenapozal hastalarda tedaviye başlanmadan önce hastanın osteoporoz açısından değerlendirilmesi ve gerektiğinde proflaksi başlanmasının önemi vurgulanmaktadır. ©2007, Fırat Üniversitesi, Tıp Fakültesi

Anahtar Kelimeler

Osteoporoz, pemfigus vulgaris, glukokortikoid

Kaynakça

• Harper KD, Weber TJ. Secondary osteoporosis Diagnostic Considerations. Endocrinol Metab Clin North Am 1998; 27: 325- 348.
• Fitzpatrick LA, Secondary causes of osteoporosis. Mayo Clin Proc 2002; 77: 453-468.
• Yosipovitch G, Hoon TS, Leok GC. Suggested rationale for prevention and treatment of glukokortikoid-induced bone loss in dermatologic patients. Arch Dermatol 2001; 137: 477-481.
• Raisz LG, Koolemans-Beynen AR. Inhibition of bone collagen synthesis by prostoglandin E2 in organ culture. Prostoglandins 1974; 8: 377-385.
• Centrella M, Casinghino S, McCarthy TL. Differantial actions of prostaglandins in separate cell populations from fetal rat bone. Endocrinology 1994; 135: 1611-1620.
• McCarty TL, Ji C, Casinghino S, Centrella M. Alternate signaling pathways selectively regulate binding of insülin-like growth factor I and II fetal rat bone cells. J Cell Biochem 1998; 68: 446- 456.
• Abadie EC, Devogealer JP, Ringe JD, et al. Recommendations for the registration of agents to be used in the prevention and treatment of glucocorticoid-induced osteoporosis: Updated recommendations from the Group for the Respect of Ethics and Excellence in Science. Arthritis Rheum 2005; 35: 1-4.
• Sambrook PN. How to prevent steroid induced osteoporosis. Ann Rheum Dis 2005; 64: 176-178.
• Laan RF, van Riel PL, van Erning LJ, Lemmens JA, Ruijs SH, van de Putte LB. Vertebral osteoporosis in rheumatoid arthritis patients: effect of low dose prednisolon therapy. Br J Rheumatol 1992; 31: 91-96.
• Michael B, Bloch D, Wolfe F, Fries J. Fractures in rheumatoid arthritis: an evaluation of associated risk factors. Br J Rheumatol. 1993; 20: 1666-1669.
• Reid IR. Glucocorticoid osteoporosis: mechanisms and management. Eur J Endocrinol 199; 137: 209-217.
• Kyle V, Hazleman BL. Treatment of polymyalgia rheumatica and giant cell arteritis, II: relation between steroid dose and steroid associated side effects. Ann Rheum Dis 1989; 48: 662-666.
• Van Staa T, Leufkens HGM, Abenhaim L, Zhang B, Cooper C. Use of oral corticosteroids and risk of fractures. J Bone Miner Res 2000; 15: 993-1000.
• Kanis JA, Delmas P, Burckhardt P, Cooper C, Torgerson D. Guidelines for diagnosis and management of osteoporosis. Osteoporos Int 1997; 7: 390-406
• Adachi JD, Ollszynski WP, Hanley D, et al. Management of corticosteroid-induced osteoporosis. Semin Arhritis Rheum 2000; 29: 228-251.
• Lukert BP, Raisz LG. Glucocorticoid-induced osteoporosis: pathogenesis and management. Ann Intern Med 1990; 112: 352- 364.
• Czerwinski SM, Kurowski TG, O’Neill TM, Hickson RC. Inititiating reguler exercise protects against muscle atrophy from glucocorticoids. J Appl Physiol 1987; 63:1504-1510.
• Kabul Tarihi: 27.02.2007