Increased bone mineral density in a man with known compression fractures

A 70-yr-old man was referred for bone mineral density because of a history of vertebral and hip fracture. His past history included prednisone-treated rheumatoid arthritis and stroke resulting in hemiparesis and expressive aphasia. He had received injections for back pain at another hospital. The overall spine T-score was +3.40 with L3 at +10.92. The overall hip T-score was -1.09 with the femoral neck at -1.75 and Ward's triangle at -2.94. Radiographs of the spine revealed increased densities of L2-4. The patient's wife provided information the aphasic patient could not. The back injections were part of a vertebroplasty for stabilization. The patient had such great pain relief that he ambulated too soon, fell, and suffered a right hip fracture. Injection of polymethylmethyacrylate is a new addition to the treatment of spinal osteoporosis. The case demonstrates the importance of acquiring a complete medical history.