1f:T40a,During the past year the authors have observed four male patients with rheumatoid arthritis in whom severe compression fractures of the vertebrae have developed during the administration of cortisone or corticotropin or both. Although demineralization of the skeleton is a recognized complication of cortisone therapy, these cases have prompted the authors to emphasize the importance of possible pathological fractures when prolonged treatment of this nature is used. Demartini, Grokoest, and Ragan,¹in 1952, reported pathological fractures in five patients who had received intensive cortisone therapy. As these authors pointed out, however, other factors predisposing to osteoporosis were present in that all five patients were women (four had passed the menopause) and three had severe rheumatoid arthritis. In the same year Teicher and Nelson²reported the case of a young woman with pemphigus vulgaris who was treated for three years with cortisone, during which time pathological compression fractures from20:T42e,Since the original description of Cushing's syndrome, it has been recognized that the prolonged maintenance of supraphysiologic levels of corticosteroids can produce severe bone loss.^1,2Studies of patients with Cushing's syndrome have demonstrated that the great majority (80% to 90%) have greatly decreased bone mass, as determined by radiological and histological criteria.^2,3Moreover, loss of bone mass occurs in a characteristic distribution; more severe osteopenia occurs in skeletal regions, such as the ribs and vertebrae, that have a high content of trabecular bone and less severe changes occur in areas such as the long bones, which are comprised primarily of compact cortical bone.^1-3As a consequence, vertebral compression and rib fractures occur commonly in this disorder.

EFFECTS OF CORTICOSTEROIDS ON BONE

Based on these observations, it is not surprising that prolonged therapeutic administration of supraphysiologic doses of corticosteroids or corticotropin often produces clinically substantial bone loss. Many

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References