全身性エリテマトーデス合併妊娠中ステロイド性骨粗鬆症にて多発脊椎椎体骨折を生じたと考えられた1例

A Case of Multiple Vertebral Fractures Caused by Glucocorticoid-induced Osteoporosis in a Pregnant Woman with Systemic Lupus Erythematosus

はじめに

　われわれは，計画外妊娠を機にステロイドを開始し，妊娠後期に多発脊椎椎体骨折を発症したと考えられた全身性エリテマトーデス（systemic lupus erythematosus：SLE）の女性に対し，周産期からリハビリテーション治療を行った．それによって，安全かつ比較的早期に日常生活能力（activities of daily living：ADL）が修正自立した経過を報告する．なお，本症例報告に関して患者本人に説明のうえ書面にて同意を得ている．

Abstract　Glucocorticoid-induced osteoporosis is one of the most common and serious adverse effects of glucocorticoid use. Pharmacological treatment is strongly recommended for patients at a high risk of fracture；however, it is generally avoided during pregnancy. Here, we present the rehabilitation of a pregnant patient with multiple vertebral fractures caused by glucocorticoid-induced osteoporosis. A 27-year-old woman with systemic lupus erythematosus had an unplanned pregnancy and began receiving oral glucocorticoid therapy (15 mg/day). Pharmacological treatment of osteoporosis was not recommended during pregnancy. At 31 weeks of gestation, the patient was admitted to our hospital with severe back pain. Plain X-rays showed multiple vertebral fractures. The patient was diagnosed with glucocorticoid-induced osteoporosis. She required prolonged bed rest until birth because of severe pain and high risk of additional fractures. The therapeutic strategy after delivery was shared with the Departments of Rehabilitation, Obstetrics, and Gynecology, Rheumatology, and Orthopedic Surgery. At 37 weeks of gestation, she gave birth by cesarean section, and teriparatide administration was started immediately. Six days after delivery, computed tomography showed multiple vertebral fractures from Th5 to L5, and L2-L4 bone mineral density was 0.798 g/cm2, which was 67％ of the young adult mean. She wore a corset and began a rehabilitation program. Frequent consultations were conducted with an orthopedic surgeon, and the patient carefully proceeded with getting out of bed. She gradually regained the ability to sit, stand, and walk. Sixty-three days after delivery, she could walk with a cane and was discharged from our hospital.