Non-traumatic Thoracic Vertebral Compression Fractures Occurred in a Young Epileptic Patient: A Case Report

INTRODUCTION: The occurrence of non-traumatic vertebral compression fractures (VCFs) in a healthy young male is very rare. We present a rare case of non-traumatic thoracic VCFs in a young epileptic patient. CASE REPORT: A 19-year-old healthy male experienced severe back pain. There had been no significant traumatic event. A radiograph of the spine showed collapsed vertebra at Th6 and Th7 and magnetic resonance image of the spine showed intensity changes at Th6, Th7 and Th8. Bone mineral density (BMD) at the radius was low and urine N-terminal telopeptide (NTx) was very high. The patient was diagnosed with VCFs caused by low BMD. The patient had a medical history of epilepsy and had taken valproate for thirteen years. We instructed the patient to stop taking valproate and to begin taking bisphosphonate. As a result, urine NTx became normal. CONCLUSION: It was previously reported that valproate reduced BMD in epileptic children and reduction in BMD increased with the duration of valproate therapy. We propose that regular BMD screening and measurement of bone metabolic markers should be conducted for all patients taking long-term antiepileptic drugs to prevent BMD loss and associated fractures.