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Heroin-induced osteoporosis presented with bilateral femoral neck insufficiency fractures in a male adult: a case report

BACKGROUND: Osteoporosis has been associated with several disorders; however, there have been only a limited number of reports on heroin-induced osteoporosis. We report a rare case presented with bilateral femoral neck insufficiency fractures without trauma history, caused by heroin-induced osteopor...

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Autores principales: Shih, Yu-Jen, Chang, Wei-Ning, Yang, Shan-Wei
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10103486/
https://www.ncbi.nlm.nih.gov/pubmed/37060059
http://dx.doi.org/10.1186/s12891-023-06377-y
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author Shih, Yu-Jen
Chang, Wei-Ning
Yang, Shan-Wei
author_facet Shih, Yu-Jen
Chang, Wei-Ning
Yang, Shan-Wei
author_sort Shih, Yu-Jen
collection PubMed
description BACKGROUND: Osteoporosis has been associated with several disorders; however, there have been only a limited number of reports on heroin-induced osteoporosis. We report a rare case presented with bilateral femoral neck insufficiency fractures without trauma history, caused by heroin-induced osteoporosis. We collect sufficient clinical data and further shed light on the potential mechanism of how heroin affects bone formation and decreases bone density. CASE PRESENTATION: A 55-year-old male patient with normal body mass index (BMI) suffered from bilateral hips pain gradually without trauma history. He had intravenous heroin addiction for more than 30 years. Radiography revealed bilateral femoral neck insufficiency fractures. Laboratory tests showed elevated alkaline phosphatase levels (365 U/L) and decreased inorganic phosphate (1.7 mg/dL), calcium (8.3 mg/dL), 25-(OH)D3 (20.3 ng/ml) and testosterone levels (2.12 ng/ml). Magnetic resonance imaging (MRI) revealed increased signals on STIR images over the sacral ala and bilateral proximal femur, and multiple band-like lesions at the vertebrae of the thoracic and lumbar spine. Bone densitometry revealed osteoporosis with a T score of minus 4.0. The screen for urine morphine was positive (> 1000 ng/ml). Through assessment of the patient, the diagnosis was insufficiency fractures of bilateral femoral neck caused by opioid-induced osteoporosis. After hemiarthroplasty, regular medication with vitamin D3 and calcium, and detoxification treatment, and the patient recovered well after 6 months of follow-up. CONCLUSION: The aim of this report is to highlight the laboratory and radiology findings in a case of osteoporosis caused by opioid addiction and discuss the potential pathway by which osteoporosis is induced by opioids. When an unusual osteoporosis presents with insufficiency fractures, heroin-induced osteoporosis should be considered.
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spelling pubmed-101034862023-04-15 Heroin-induced osteoporosis presented with bilateral femoral neck insufficiency fractures in a male adult: a case report Shih, Yu-Jen Chang, Wei-Ning Yang, Shan-Wei BMC Musculoskelet Disord Case Report BACKGROUND: Osteoporosis has been associated with several disorders; however, there have been only a limited number of reports on heroin-induced osteoporosis. We report a rare case presented with bilateral femoral neck insufficiency fractures without trauma history, caused by heroin-induced osteoporosis. We collect sufficient clinical data and further shed light on the potential mechanism of how heroin affects bone formation and decreases bone density. CASE PRESENTATION: A 55-year-old male patient with normal body mass index (BMI) suffered from bilateral hips pain gradually without trauma history. He had intravenous heroin addiction for more than 30 years. Radiography revealed bilateral femoral neck insufficiency fractures. Laboratory tests showed elevated alkaline phosphatase levels (365 U/L) and decreased inorganic phosphate (1.7 mg/dL), calcium (8.3 mg/dL), 25-(OH)D3 (20.3 ng/ml) and testosterone levels (2.12 ng/ml). Magnetic resonance imaging (MRI) revealed increased signals on STIR images over the sacral ala and bilateral proximal femur, and multiple band-like lesions at the vertebrae of the thoracic and lumbar spine. Bone densitometry revealed osteoporosis with a T score of minus 4.0. The screen for urine morphine was positive (> 1000 ng/ml). Through assessment of the patient, the diagnosis was insufficiency fractures of bilateral femoral neck caused by opioid-induced osteoporosis. After hemiarthroplasty, regular medication with vitamin D3 and calcium, and detoxification treatment, and the patient recovered well after 6 months of follow-up. CONCLUSION: The aim of this report is to highlight the laboratory and radiology findings in a case of osteoporosis caused by opioid addiction and discuss the potential pathway by which osteoporosis is induced by opioids. When an unusual osteoporosis presents with insufficiency fractures, heroin-induced osteoporosis should be considered. BioMed Central 2023-04-14 /pmc/articles/PMC10103486/ /pubmed/37060059 http://dx.doi.org/10.1186/s12891-023-06377-y Text en © The Author(s) 2023 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Case Report
Shih, Yu-Jen
Chang, Wei-Ning
Yang, Shan-Wei
Heroin-induced osteoporosis presented with bilateral femoral neck insufficiency fractures in a male adult: a case report
title Heroin-induced osteoporosis presented with bilateral femoral neck insufficiency fractures in a male adult: a case report
title_full Heroin-induced osteoporosis presented with bilateral femoral neck insufficiency fractures in a male adult: a case report
title_fullStr Heroin-induced osteoporosis presented with bilateral femoral neck insufficiency fractures in a male adult: a case report
title_full_unstemmed Heroin-induced osteoporosis presented with bilateral femoral neck insufficiency fractures in a male adult: a case report
title_short Heroin-induced osteoporosis presented with bilateral femoral neck insufficiency fractures in a male adult: a case report
title_sort heroin-induced osteoporosis presented with bilateral femoral neck insufficiency fractures in a male adult: a case report
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10103486/
https://www.ncbi.nlm.nih.gov/pubmed/37060059
http://dx.doi.org/10.1186/s12891-023-06377-y
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AT yangshanwei heroininducedosteoporosispresentedwithbilateralfemoralneckinsufficiencyfracturesinamaleadultacasereport