Objective: The purpose of this case report is to describe the clinical presentation, radiographic examination, physiological, pathological, psychosocial factors, and management of the progression of osteoporosis with multiple vertebral compression fractures (VCF). What is unique about this case is the timeline and co-existing elements of food insecurity, addiction and poverty that contributed to the fractures.
Clinical Features: A 61-year-old male sought care for mild low back and neck pain at a chiropractic college outpatient clinic. DEXA examination over a decade prior identified osteopenia after warfarin use for several years. Initial x-ray examination of the lumbar spine at the onset of care noted adequate bone density by the radiologist. Over the course of the next 3 years, the patient developed osteoporosis seen on plain film, with multi-level vertebral compression. Progression was unrelated to the history of current cancer or additional drug-nutrient deficiency. Rapid progression of compression fracture is suspected to be potentially correlated with food insecurity, familial factor V Leiden and history of psoriasis, a chronic inflammatory disease with multiple comorbidities linked to increased risk of pathologic fractures and osteoporosis.
Intervention and Outcome: His chronic low back pain was managed using conservative chiropractic intervention with outcome improvement. Over the course of care, a prior vertebral compression fracture and rib fracture were discovered with 2 additional vertebral compression fractures occurring due to injury, ultimately leading to fracture with 60% loss of vertical height. Clinical care was suspended at this time and referral to the primary care physician for further imaging and management was initiated.
Conclusion: Further complicating this case is the history of drug-induced nutrient depletion leading to osteopenia and history of long-term psoriasis connected to an increased risk of pathologic fractures and osteoporosis. When considering the potential presence of VCF in patients, social, emotional and financial factors, and how they complicate access to appropriate nutrients and health care, should be considered.
Author keywords: Chiropractic; Compression Fracture; Low Back Paint
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