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  • Coincidence of asymptomatic avascular necrosis and fracture of the femoral neck: a rare combination of glucocorticoid induced side effects

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Letter
Coincidence of asymptomatic avascular necrosis and fracture of the femoral neck: a rare combination of glucocorticoid induced side effects
  1. K Loddenkemper,
  2. C Perka,
  3. G-R Burmester,
  4. F Buttgereit
  1. Departments of Rheumatology/Clinical Immunology and Orthopaedics, Charité University Hospital, Humboldt University of Berlin, Germany
  1. Correspondence to:
    Dr K Loddenkemper, Department of Rheumatology/Clinical Immunology, Charité University Hospital, Schumannstrasse 20–21, 10117 Berlin, Germany;
    konstanze.loddenkemper{at}charite.de

https://doi.org/10.1136/ard.61.7.665

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    Glucocorticoids have profound anti-inflammatory and immunosuppressive actions when used therapeutically. Unfortunately, these drugs have adverse effects—for example, on bone metabolism. Osteoporosis is well known to be a common side effect, whereas a glucocorticoid associated avascular osteonecrosis is rarely diagnosed. However, as far as we know, the coincidence of manifest osteoporosis with fracture and avascular osteonecrosis in the same area is unique.

    CASE REPORT

    We present the case of a 47 year old postmenopausal woman who had had mixed connective tissue disease (MCTD) for more than 20 years. The MCTD was complicated by progressive vasculitis, and had required immunosuppressive treatment with prednisolone (maximum dose 500 mg/day (pulse therapy; average dose 15 mg/day) for 20 years and azathioprine (75 mg/day). In 1995, she complained for the first time of severe back pain and noticed a height loss of 10 cm within two years. There was no history of previous fractures.

    Glucocorticoid induced osteoporosis was suspected. Indeed, bone densitometry (DXA-LUNAR) showed decreased bone mineral density (BMD) of the lumbar spine (L2–4) …

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