| Abstrakt: |
Introduction: The number of patients with osteoporotic fractures is increasing annually and mainly concerns older postmenopausal women. Along with the increased number of elderly patients with severe osteoporosis, more and more cases of pelvic fragility fractures (PFFs) are being reported, which are more often found in the areas of the sacrum and pubic rami. The aim of this study was to evaluate the clinical features and therapeutic effects of teriparatide (TPD) use in patients with PFFs. Methods: Between 2014 and 2016, 32 patients (26 women and 6 men) with PFFs were treated in our clinic and their medical records were checked retrospectively. They all suffered from osteoporosis and their mean value of T-Score in the lumbar spine was -3.8 (range -2.9 to -5.8). In all cases, the diagnosis of fractures was based on plain radiographs (PR) and computed tomography (CT) of the pelvis. Additional MRI and bone scintigraphy tests were needed in 4 and 8 cases, respectively, to confirm the diagnosis. Patients were treated conservatively with bed rest and gradual mobilization within one month of injury (as tolerated), analgesics, vitamin D (25kIU p.o / week), and calcium (1000mg p.o / day) supplements. In 14 cases, TPD (20µg / day s.c.) was administered within two weeks of injury. Post-fracture patient follow-up was initially performed every 4 weeks for the first 6 months and every 3 months thereafter and was based on radiological (PR and/or CT) and clinical (Visual Analogue Scale of Pain/VAS) criteria. Results: The mean patient age was 76.8 (69-83) years. PFFs were located: in the sacrum and the pubic rami together (6 patients), in the sacrum (12 patients), in the pubic rami (14 patients). In one case where there was a fracture displacement and pain exacerbation at 4-week follow-up, it was performed percutaneous sacro-iliac fixation with cannulated screws. The duration of fracture healing was significantly shorter in patients using TPD (P < 0.05). The mean value of VAS was also lower in patients receiving TPD, however, there was no statistically significant difference with the others. Conclusion: In osteoporotic patients with pelvic pain and without major injury, we should always suspect the presence of PFFs. While conservative treatment has been shown to be adequate, in this study it appears that PTH treatment reduces time of fracture union and could be a favorable treatment option. [ABSTRACT FROM AUTHOR] |
