A case of bilateral stress fractures in an old woman: three years of pain

Abstract

SummaryIn elderly patients frequent episodes of joint pain of lower limbs exacerbated by stress and resistant to treatment occur frequently. This paper reports a case of a long lasting bilateral atraumatic knee pain with a final diagnosis of bilateral stress fractures of proximal tibia in osteoporotic postmenopausal woman. The distinctive trait of this case is that the fracture has set in bilaterally and associated with an isthmic L4-L5 spondylolisthesis in a patient afflicted by a decline in mood. This particular clinical picture has delayed the diagnosis and the suitable treatment for 3 years. Therapy for this type of patients must aim in the acute phase at pain relief and only after must be settled in a long term antiosteoporotic therapy. We choose clodronate acyd for pain relief and after strontium ranelate for osteoporosis prevention.

Bilateral Simultaneous Proximal Tibial Insufficiency Fractures in a Patient Suffering From Psoriatic Arthritis

“…Risk factors are related to osteoporotic conditions that may impair bone strength. Subsequently, osteoporosis may be related to ageing, female sex and early menopause, white race, low body mass index (BMI), sedentary life and prolonged immobilization, chronic inflammatory disorders, corticosteroid and methotrexate medication, smoking and alcohol abuse [1,4,8,9]. Our patient mustered a series of these factors; the most important of which were that she suffered from psoriatic arthritis and was on chronic steroid use.…”

“…Proximal tibia insufficiency fractures are seldomly reported and treatment protocols usually involve rest and weight-bearing constraint measures [3,5,6]. Misdiagnosis leading to inappropriate management is typical for this condition since radiographic evaluation in early stages is usually inconclusive [3][4][5][6]. We report a case of simultaneous proximal tibia bilateral insufficiency fractures in a 51-yearold female patient with underlying psoriatic arthritis.…”

“…Insufficiency fractures are also common; however, they require presence of an abnormal medical condition that affects bones (osteoporosis) by making them more vulnerable to load application [1]. Subsequently, poor bone quality diminishes energy load required to produce breakage [1,4].…”

Bilateral Tibia Distal Metafiz Stres Kırığı - Olgu Sunumu

“…Tüm bu çalışmalarda hastalar alçı ve sonrasında fizik tedavi programı ile konservatif olarak tedavi edilmişlerdir. Bu yazarlar; konservatif tedavi yöntemleri, aktivite modifikasyonu ve değiştirilebilir risk faktörlerinin düzenlenmesi ile hastalarının tedavisinin başarıya ulaştığını belirtmişlerdir (8,(13)(14)(15)(16)(17)(18). Hastamızın yaşının daha genç olması ve doğum sonrası erken aktif zorlamalı spor yapma öyküsünün olması literatürden farklı olarak belirtebileceğimiz durumlardır.…”

Stress Fracture of Bilateral Distal Tibia Provoked by Stair Climbing

“…Although there is no consensus, as the pathogenesis of stress fracture is multifactorial, several risk factors have been identified. Some of these risk factors are advanced age, female gender, white ethnicity, vitamin D receptor polymorphism, low vitamin D levels, high levels of parathormone, low bone mineral density and content, tall height, poor general condition, iron deficiency, steroid use, bisphosphonate treatment, cigarette smoking, alcoholism [2] [4] [5]. With repeated overloading, because the increase in osteoclastic activity is greater than osteoblastic activity in the stress fracture process, microfractures and defects in the trabecular structure develop as this newly-formed bone tissue is weaker and more porotic and with progression of the disease, callus formation develops around these microfractures [5].…”