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Osteonecrosis in a patient with osteoporosis -- The conditions rarely have been reported coincidentally in the vertebrae.

Article Excerpt
Byline: DAVID PUGLIESE, DO, THOMAS OLENGINSKI, MD

ABSTRACT: Osteoporosis, the most common metabolic bone disease, has significant physical and emotional sequelae. Complicating identification of the disease is its silent nature. Although patient risk factors can be identified easily, patients may not perceive any symptoms to report, even in the face of advanced disease. Patients of particular concern are long-term corticosteroid users. It has been proposed that osteoporotic compression fractures predispose vertebrae to osteonecrosis, particularly in this patient population, or conversely, that osteonecrosis may precede structural change in the vertebrae. We present a case of asymptomatic vertebral osteonecrosis in the setting of corticosteroid-induced osteoporosis. (J Musculoskel Med. 2007;24:174-176)

Osteoporosis is a chronic disease characterized by a generalized loss of bone mass and bone strength. Osteonecrosis is a destructive process that involves disruption of blood flow and alterations in intraosseous pressures that ultimately lead to structurally impaired bone. Although both conditions are associated with long-term use of corticosteroids, they rarely have been reported coincidentally in the vertebrae.

In this article, we report a case of vertebral osteonecrosis as an incidental finding in a person who was enrolled in an osteoporosis screening program for long-term corticosteroid users. This case illustrates both the destructive nature and the silent character of osteoporosis.

BACKGROUND

An estimated 28 million Americans have or are at risk for osteoporosis.1 The lifetime risk of fracture in women and men older than 50 years is estimated at 40% and 13%, respectively.1-3

In osteonecrosis, interference with the vascular supply to bone results in bone death and necrosis, followed by structural...