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Abstract: Osteoporosis refers to a decrease in bone density and quality and destruction of bone microarchitecture, and is mostly seen in the elderly and postmenopausal women, but patients with limb movement disorders can also lead to disuse osteoporosis. In this case, the patient had a large bone defect after a comminuted fracture of the lower leg, which required bed rest during the long period of treatment of the bone defect and prolonged weight-bearing of the lower limb, resulting in disuse osteoporosis of the lower leg and ankle over time. After timely treatment, the patient’s condition improved significantly and basically restored normal walking function.
Basic information】Male, 39 years old
Disease Type】Destructive osteoporosis, bone loss
Hospital】The First Hospital of Harbin Medical University
Date of consultation】April 2021
Treatment plan】Bone removal surgery + functional exercise + medication (calcium carbonate D3 tablets)
Treatment Period】Hospitalization for 10 days, review after 3 months
Effectiveness】The condition improved significantly, and basically restored normal walking function
I. Initial consultation
One year ago, the patient suffered a crush fracture of the calf, which was treated with several surgeries in the hospital, and due to the large bone defect in the calf, she has been resting in bed at home and did not go to the ground. The main request of this hospitalization was to treat the bone defect completely. Due to the multiple surgeries and prolonged bed rest, the patient’s right calf was covered with scarring and was significantly thinner, and the ankle movement was not very flexible. From the imaging, it could be observed that the bone cortex of the patient’s calf, ankle and foot was significantly thinner and translucent areas of varying sizes appeared within the osteophytes, all of which indicated that the patient’s bone was already very weak. Due to the lack of stress stimulation for a long time, the patient has developed disuse osteoporosis.
II. Treatment history
After admission, the patient was first treated for the bone defect, the calf was radiographed, the lower extremity vascular ultrasound was improved, routine blood count, hematocrit, C-reactive protein, liver and kidney, and coagulation function were checked, the preoperative preparation was improved, and after excluding occult infection, the patient underwent bone handling surgery. During the treatment of the bone defect, the treatment for disuse osteoporosis of the affected limb was also carried out simultaneously. The patient began functional exercises, which allowed him to perform bed stirrups, practice calf muscle contractions, and use the affected limb on the healthy side to move off the bed with the help of others. Oral calcium carbonate D3 tablets were administered and the diet was adjusted to increase calcium and protein intake. The patient was discharged 10 days after surgery and reviewed in 3 months.
III. Treatment effect
At the time of discharge, the patient was able to use the healthy limb for weight-bearing activities, and the bone defect healed at 4 months after surgery. During the treatment of the bone defect, the muscle atrophy of the affected limb improved, the muscle strength increased, and the knee and ankle joints moved normally. One month after the healing of the bone defect, the affected limb was walking under the protection of crutches with no pain and discomfort and mild swelling. Four months after the healing of the bone defect, the disuse osteoporosis was obviously improved and the normal walking function was basically restored.
IV. Notes
We are glad that after treatment the patient has increased bone mass and regained walking function of the lower extremities, because this patient has a long treatment period and therefore requires long-term adherence to exercise and follow-up. During the treatment period of bone defect, although the affected limb cannot bear weight, muscle contraction exercise and stirrups can be performed in bed, and weight-bearing activities with the healthy limb can also be performed on the ground. After the treatment of bone defect, the initial exercise is still based on the healthy limb, and gradually transition to the affected limb, which should not be rushed. Regular oral calcium carbonate D3 tablets are required throughout the rehabilitation cycle, and the diet should be strengthened with calcium and protein intake, and X-rays should be taken every 3 months for review, and bone density should be reviewed once a year.
V. Personal insight
Disuse osteoporosis belongs to a kind of secondary osteoporosis, that is, this kind of osteoporosis is caused by other diseases, the treatment should first focus on the primary disease and start active anti-osteoporosis treatment on the basis of treating the primary disease. This patient has wasting osteoporosis caused by long-term bed rest due to bone defect. Treatment of bone defect should be given first priority, and when the bone defect is healed, supplemented by osteoporosis treatment, most of them can achieve good treatment effect.