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Archives of Orthopaedic and Trauma Surgery

, Volume 134, Issue 2, pp 173–179 | Cite as

Pregnancy-associated osteoporosis with eight fractures in the vertebral column treated with kyphoplasty and bracing: a case report

  • J. BonackerEmail author
  • M. Janousek
  • M. Kröber
Orthopaedic Surgery

Abstract

Pregnancy-associated osteoporosis is a rare condition, which imposes multiple symptoms in the musculoskeletal system. Common complaints announced by patients are severe pain in the lower back, hips and the joints of the lower extremities with a reduced and less mobility status in general. Most of the patients’ problems occur in the last trimester of pregnancy or postpartum and are often not diagnosed as side effects of osteoporosis but as problems associated with pregnancy. Although vertebral fractures are rare complications of pregnancy-associated osteoporosis, they should be always considered in women presenting with an acute pain syndrome in peripregnancy period. This case presents a 40-year-old primagravid woman who developed pain in hips and severe pain in the lower back causing an immobilization diagnosed with a pregnancy-associated osteoporosis with eight compression fractures in the thoracic and lumbar spine. Because of sagittal imbalance of the spine, she was treated with kyphoplasty at the four lumbar fractures and with bracing for the upper, thoracic ones, additional to the conservative anti-osteoporotic therapy. The authors discuss pregnancy-associated osteoporosis and its clinical presentation, as well as the indications of kyphoplasty, spinal alignment and the risk of single conservative treatment.

Keywords

Pregnancy-associated osteoporosis Kyphoplasty Spine fractures 

Notes

Conflict of interest

None.

References

  1. 1.
    Khovidhunkit W, Epstein S (1996) Osteoporosis in pregnancy. Osteoporos Int 6(5):345–354PubMedCrossRefGoogle Scholar
  2. 2.
    Mahadevan S, Kumaravel V, Bharath R (2012) Calcium and bone disorders in pregnancy. Indian J Endocrinol Metab 16(3):358–363PubMedCentralPubMedCrossRefGoogle Scholar
  3. 3.
    Di Gregorio S et al (2000) Osteoporosis with vertebral fractures associated with pregnancy and lactation. Nutrition 16(11–12):1052–1055PubMedCrossRefGoogle Scholar
  4. 4.
    Wisser J et al (2005) Changes in bone density and metabolism in pregnancy. Acta Obstet Gynecol Scand 84(4):349–354PubMedGoogle Scholar
  5. 5.
    Dunne F et al (1993) Pregnancy associated osteoporosis. Clin Endocrinol (Oxf) 39(4):487–490CrossRefGoogle Scholar
  6. 6.
    Peris P et al (2002) Pregnancy associated osteoporosis: the familial effect. Clin Exp Rheumatol 20(5):697–700PubMedGoogle Scholar
  7. 7.
    Heim U et al (2010) Schwangerschafts-assozierte Osteoporose. Der Orthopäde 09/2010. Springer, pp 1051–1056Google Scholar
  8. 8.
    Graziotti PJ, Graziotti CR, Sangster AM (2013) Significance of preoperative MRI in establishing levels of augmentation for percutaneous vertebroplasty. J Pain Res 6:359–365PubMedCentralPubMedCrossRefGoogle Scholar
  9. 9.
    O’Sullivan SM et al (2006) Bisphosphonates in pregnancy and lactation-associated osteoporosis. Osteoporos Int 17(7):1008–1012PubMedCrossRefGoogle Scholar
  10. 10.
    Ofluoglu O, Ofluoglu D (2008) A case report: pregnancy-induced severe osteoporosis with eight vertebral fractures. Rheumatol Int 29(2):197–201PubMedCrossRefGoogle Scholar
  11. 11.
    Bayram S et al (2006) Kyphoplasty for pregnancy-associated osteoporotic vertebral fractures. Joint Bone Spine 73(5):564–566PubMedCrossRefGoogle Scholar
  12. 12.
    Silverman SL (1992) The clinical consequences of vertebral compression fracture. Bone 13(Suppl 2):S27–S31PubMedCrossRefGoogle Scholar
  13. 13.
    Kim HW et al (2010) Percutaneous vertebroplasty for pregnancy-associated osteoporotic vertebral compression fractures. J Korean Neurosurg Soc 47(5):399–402PubMedCentralPubMedCrossRefGoogle Scholar
  14. 14.
    Vujasinovic-Stupar N et al (2012) Pregnancy-associated spinal osteoporosis treated with bisphosphonates: long-term follow-up of maternal and infants outcome. Rheumatol Int 32(3):819–823PubMedCrossRefGoogle Scholar
  15. 15.
    Donovan MA, Khandji AG, Siris E (2004) Multiple adjacent vertebral fractures after kyphoplasty in a patient with steroid-induced osteoporosis. J Bone Miner Res 19(5):712–713PubMedCrossRefGoogle Scholar
  16. 16.
    Gui XG et al (2013) Analysis of perioperative complications of percutaneous kyphoplasty for osteoporotic vertebral compression fracture. Zhongguo Gu Shang 26(3):205–209PubMedGoogle Scholar
  17. 17.
    Ferraris L (2012) Die Bedeutung der sagittalen Balance in der Wirbelsäulenchirurgie (The relevance of the sagittal balance in spine surgery). In: OUP; Koller H (eds) Deutscher Ärzte Verlag, Werner-Wicker-Klinik, Bad Wildungen, pp 502–508Google Scholar
  18. 18.
    Chaléat-Valayer E et al (2011) Sagittal spino-pelvic alignment in chronic low back pain. Eur Spine J 20(Suppl 5):634–640PubMedCentralPubMedCrossRefGoogle Scholar
  19. 19.
    Faundez A, Roussouly P, Le Huec JC (2011) Sagittal balance of the spine: a therapeutic revolution. Rev Med Suisse 7(322):2470–2474PubMedGoogle Scholar
  20. 20.
    Koller H et al (2008) Long-term investigation of nonsurgical treatment for thoracolumbar and lumbar burst fractures: an outcome analysis in sight of spinopelvic balance. Eur Spine J 17(8):1073–1095PubMedCentralPubMedCrossRefGoogle Scholar
  21. 21.
    Hempfing A et al (2011) Restoration of sagittal balance in treatment of thoracic and lumbar vertebral fractures. Orthopade 40(8):690–702PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  1. 1.University of RostockRostockGermany
  2. 2.Department for RheumatologyHirslanden St Anne HospitalLucerneSwitzerland
  3. 3.Department for Traumatology, Orthopedic Surgery and Spine SurgeryAsklepios Hospital AltonaHamburgGermany

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