CASE REPORT and REVIEW - Insufficiency fractures in rheumatology

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Z Rheumatol. 2006 Aug 31; [Epub ahead of print]

[insufficiency fractures in rheumatology : Case report and overview.]

Kommission Osteologie DGRh (Sprecher G. Hein), .

Stress fractures occur as insufficiency fractures, with a prevalence of 0.8%

in patients with rheumatological illness. The main sites of insufficiency

fractures are the pelvis and sacrum, parts of the tibia and fibula that are

close to the joints, and the calcaneus and hip. Since the painful symptoms

overlap with the clinical picture of the painful joint diseases and because

of the low sensitivity of conventional diagnostic X-ray, insufficiency

fractures are not diagnosed directly or their diagnosis is delayed.The high

sensitivity of computer tomography, skeletal scintigraphy and nuclear

magnetic resonance imaging should be exploited in the diagnosis of

insufficiency fractures. The case report presented describes insufficiency

fractures of the distal right tibia and fibula in an elderly female patient

with rheumatoid arthritis being treated with long-term glucocorticoids. In

addition to advanced age, female gender, immobility and rheumatoid arthritis

requiring long-term cortisone, there are further risk factors for

insufficiency fractures: fluoride treatment over many years in the past,

hypovitaminosis D3, renal failure. The DXA bone density values of the neck

of the femur and the lumbar vertebrae do not show any osteoporosis, and the

calcium concentration in the serum is low; phosphate is raised and

parathormone is normal; osteocalcin, beta crosslaps and alkaline phosphatase

are raised. Bone biopsy specimens taken from the iliac crest and the

proximal femur and investigated for the purpose of differential diagnosis

revealed renal osteopathy with secondary hyperparathyroidism and

osteomalacia. In elderly patients with kidney failure, the possibility of

renal osteopathy must be considered as the possible cause of reduced bone

quality with a raised risk of insufficiency fractures, even when the

parathormone levels are normal. In view of the frequency of osteopathies in

rheumatological patients, osteology is of enormous significance in

rheumatology.

PMID: 16944082

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed & cmd=Retrieve & dopt=Abstra\

ctPlus & list_uids=16944082

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