Total Femoral Head Collapse in a Corticosteroid-Induced Pathologic Fracture

TL;DR

A 78-year-old woman experienced severe bone collapse due to high-dose corticosteroid use, highlighting the risks of steroid-induced osteoporosis.

Contribution

This case uniquely highlights the extreme steroid dosage and timing leading to femoral head collapse, emphasizing preventive measures for glucocorticoid-induced osteoporosis.

Findings

High-dose corticosteroid therapy led to avascular necrosis and complete femoral head collapse.

Protrusio acetabuli was observed in imaging, indicating severe bone degradation.

Preventive measures like bone density scans and anti-osteoporotic medications are critical for managing GIOP.

Abstract

Glucocorticoid therapy is a well-established iatrogenic cause of secondary osteoporosis. This form of osteoporosis is known as glucocorticoid-induced osteoporosis (GIOP). We present the case of a 78-year-old woman who developed avascular necrosis and complete collapse of the femoral head after a high-dose steroid taper for asthma. Imaging showed subsequent femoral head collapse with the presence of protrusio acetabuli. The patient underwent a posterior total hip arthroplasty. This case is unique because of the extremely high dose of steroids and the timing of her fracture. The case reveals the adverse effects of prolonged glucocorticoid use on bone health, showing the need for proper preventive measures such as bone density scans and proper supplementation if needed. Using anti-osteoporotic medications such as bisphosphonates or denosumab can mitigate the occurrence of GIOP. Early recognition and proper management are critical in decreasing the incidence of GIOP-related fractures.

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