This defect occurs between the third and sixth weeks of gestation 2,3 and is located most frequently at 5–7 the lumbar level. The patient was diagnosed with densitometric osteoporosis and the onset of antiresorptive therapy was postponed.īutterfly vertebra (also known as vertebral sagittal cleft, anterior rachischisis, somatoschysis, spina bifida or above) 1 is a rare congenital malformation caused by the failure of fusion of the lateral chondrification nuclei of vertebrae developing, 2,3 secondary to incomplete embryological regression originating in the notochordal sagittal funnel shaped groove into the vertebral body, through which the adjacent vertebral discs 4 are connected. A lateral spine X-ray showed an apparent severe anterior vertebral collapse at D10, but magnetic resonance imaging (MRI) revealed that this actually corresponded to a typical ‘butterfly vertebra’ ( Figs. Densitometry showed spinal ( T score: −2.8) and femoral neck osteoporosis ( T score: −3.2). Laboratory tests, including calcium, phosphorus, parathyroid hormone, thyrotropin, 25 (OH) vitamin D3, calciuria and tubular reabsorption of phosphate, were normal. On examination, her height was 147 cm, and she weighed 58 kg (BMI 26), and presented mild thoracolumbar kyphosis with left convexity scoliosis but the spinal mobility and neurological examination were normal. The vertebral collapse was assumed to be asymptomatic as there was no pain or a history of previous trauma. She had recently been diagnosed with hypercholesterolemia and received simvastatin, but denied using other drugs. She had a calcium intake over 1000 mg/day, as well as adequate sun exposure and physical activity, and had no history of previous fractures, thyroid disease or urolithiasis. She reported her menarche at age 15 and menopause at age 45. A female 62-year-old patient was diagnosed with osteoporotic compression fractures at the D10 level and referred to a tertiary center for study and initiation of antiresorptive therapy.
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