Vertebroplasty for Treatment of Steroid-Induced Osteoporotic Vertebral Compression Fractures in an Adolescent With Duchenne Muscular Dystrophy

Duchenne muscular dystrophy (DMD) is an x-linked genetic disorder and the most common muscular dystrophy of childhood, with an incidence of 1 in 3500 male births and an average life expectancy of 22 years without ventilatory support [8]. Daily long-term corticosteroid use has become the standard of care for patients with DMD; it slows the decline in muscle strength and function and significantly postpones disease progression, reduces mortality, and decreases time-to-disease milestones [10]. However, regular corticosteroid use causes osteoporosis, which results in an increased risk of bone loss and osteoporotic fractures [13]. Corticosteroid-induced osteoporosis results from the inhibition of osteoblast formation, decreasing calcium absorption in the gastrointestinal tract, and increasing bone resorption and renal calcium excretion [13]. Progressive development of osteoporosis causes vertebral compression fractures (VCFs). In the pediatric population receiving corticosteroid therapy, the prevalence of VCFs is reported to be between 7% and 34% [11,14,15]. Of pediatric patients with VCF, 44% to 81% are asymptomatic [9,11] and the most symptomatic children have mild and transient symptoms [9]. A small number of patients have severe symptoms and that require treatment. Calcium, vitamin D, and bisphosphonates are used in symptomatic patients [7]. When medication fails to address symptoms, percutaneous vertebroplasty has the potential to enhance patients’ quality of life and mobility. However, the literature regarding this procedure in pediatric osteoporotic fractures is limited; it includes just a few publications [3,5,7] and only one that addresses patients with DMD [3]. As a result, there is a lack of information on indications, outcomes, and patient management, which makes it challenging to plan this complex treatment. We present a case study involving the successful use of vertebroplasty in the treatment of a patient with DMD whose symptoms, caused by osteoporotic VCFs, could not be alleviated by medication. Management challenges, dilemmas, and implications for the treatment of this compromised patient population are discussed.