OSTEOPOROTIC VERTEBRAL FRACTURES IN A MAN UNDER HIGH-DOSE INHALED GLUCOCORTICOID THERAPY - A CASE-REPORT WITH A REVIEW OF THE LITERATURE

A 65-year-old man had surgery in June 1995 for femoral neuralgia. The plain films of the spine were normal at the time. In September of the same year, when he was beginning to walk gradually longer distances, h e started experiencing back pain. Crush fractures of T8 and L2 were se en on plain films. His pain worsened, and he was admitted in December 1995. A third set of plain films disclosed fractures of all the verteb ral bodies from T8 through L5, with increased density of the endplates of the same vertebras. Serum and urinary levels of calcium and phosph ate were normal. Dual-energy X-ray absorptiometry demonstrated osteopo rosis predominating in the trabecular bone. Evidence of increased bone resorption was seen on the histomorphometric study. Large amounts of dihydroxypyridinoline were found in the urine. Investigations for the classical causes of osteoporosis in males were unrewarding. Careful qu estioning revealed that the patient had been taking inhaled beclometha sone for seven years to treat chronic obstructive lung disease. Serum levels of cortisol and ACTH were low, consistent with a diagnosis of t reatment induced hypercorticism. To our knowledge, this is the first r eported case of osteoporotic vertebral fractures in a male due to inha led glucocorticoid therapy. Inhaled glucocorticoids are generally beli eved to induce only minimal systemic effects. However decreased serum osteocalcin levels and increased urinary excretion of bone resorption markers have been reported in patients under inhaled beclomethasone th erapy. Low spinal bone mineral density values correlated with the degr ee of pituitary-adrenal gland suppression as evaluated using the ACTH test have also been found in several groups of patients treated with i nhaled glucocorticoids.