J Bone Metab.  2012 Nov;19(2):133-138. 10.11005/jbm.2012.19.2.133.

A Case with Multiple Punched-out Lesions in the Skull and Generalized Fractures Associated with Steroid-induced Osteoporosis

• Ko SH
• Lee KY
• Kim KH
• Kim YM
• Lee KS
• Yeom SJ
• Kang MI

• KMID: 1975987
• DOI: http://doi.org/10.11005/jbm.2012.19.2.133

Abstract

Steroid-induced osteoporosis is the most common cause of secondary osteoporosis and accounts for one-fifth of all osteoporosis cases. The fracture incidence under steroid may be as high as 50%. However, many patients do not undergo appropriate risk assessment and treatment before and after steroid exposure. We described a 56-year-old male patient with multiple punched-out lesions in skull unusually as well as vertebral, fibular, rib and humeral fractures during steroid use without proper management.

Keyword

Fracture; Punched-out lesions; Steroid-induced osteoporosis

MeSH Terms

Humans
Humeral Fractures
Incidence
Male
Middle Aged
Osteoporosis
Ribs
Risk Assessment
Skull

Figure

• 

  Fig. 1 (A) Six months ago, sagittal T2-weighted MRI of the thoracic spine showed acute compression fractures at T9 and T12. (B) After kyphoplasty, sagittal T2-weighted MRI of the lumbar spine showed acute compression fractures at T8, T10 and T11 and prominent fracture lines at T9 and T12.

• 

  Fig. 2 (A) Lateral radiograph of the skull demonstrates multiple punched-out lesions with variable sizes on the parietal region. (B) Lateral radiograph of thoracic spine shows kyphosis of the thoracic vertebrae and multiple compression fractures with vertebroplasty segments at T8 through T12. (C) Posteroanterior plain radiograph demonstrates a left healed fibular fracture.

• 

  Fig. 3 (A) Sagittal fat-suppressed contrast-enhanced T2 weighted MRI of the spine shows spondylitis of T8, 9, 10 with left paraspinal and anterior subligamentous abscesses (arrow head) and compression fractures at T8 through L5. (B) Low bone mineral density at lumbar spine and left femur is demonstrated, indicating "osteoporosis". AP, anteroposterior; BMD, bone mineral density.

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