title: An osteoporotic fracture mimicking cervical dystonia in idiopathic Parkinson's disease.
abstract: We report on a case of a 65-year-old (CD) woman who sustained an atraumatic neck fracture. A combination of Parkinson's disease with motor fluctuations, chronic cervical dystonia and osteoporosis provided the basis for this interesting diagnosis. Mrs CD had progressed to complex phase idiopathic Parkinson's disease within 13 years of diagnosis. During this time she remained independent, only using a wheelchair when her motor fluctuations were bad. In 2011, she developed a sudden onset of neck spasm and occipital neuralgia, initially attributed to severe spasmodic cervical dystonia. Despite a titration regime of analgesics and weaning off of her Parkinson's disease medications, the pain persisted. An X-ray of her cervical spine showed degenerative discopathies from C4 to C7. Mrs CD underwent a trial of Botox injections to no avail and she was admitted acutely under the spinal team after an MRI of her spine showed abnormal oedema of the odontoid peg. Subsequent CT diagnosed a type II fracture of the odontoid peg on the background of severe osteoporotic bone (spinal T score -3.4 on subsequent DEXA scan) and she underwent a successful occipital cervical fusion of C1-C6. What makes this case interesting is the fact that this lady's profound powerful neck movements on a background of osteoporosis led to fracture of her neck. Post-operatively, she admitted to non-adherence to her bisphosphonates, prioritising levodopa in the morning with food rather than taking her alendronate on an empty stomach. She is now pain free and receives annual zolendronate infusions.
authors.affiliation: Royal Devon and Exeter Hospital, Geriatric Medicine, William Wright House Barrack Road, Exeter EX2 5 DW, UK. c.ostrowski@nhs.net
authors.forename: Caroline
authors.initials: C
authors.lastname: Ostrowski
authors.forename: Lindsay
authors.initials: L
authors.lastname: Ronan
authors.forename: Ray
authors.initials: R
authors.lastname: Sheridan
authors.forename: Vaughan
authors.initials: V
authors.lastname: Pearce
mesh_terms: D015502:Absorptiometry, Photon; D000368:Aged; D000978:Antiparkinson Agents / Q000627:therapeutic use; D050071:Bone Density Conservation Agents / Q000627:therapeutic use; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000293:injuries* / Q000473:pathology / Q000601:surgery; D003937:Diagnosis, Differential; D018450:Disease Progression; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D055118:Medication Adherence; D009048:Motor Skills; D019547:Neck Pain / Q000209:etiology; D010024:Osteoporosis / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D058866:Osteoporotic Fractures / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D010300:Parkinson Disease / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy / Q000503:physiopathology; D011237:Predictive Value of Tests; D016103:Spinal Fractures / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D013123:Spinal Fusion; D014057:Tomography, X-Ray Computed; D014103:Torticollis / Q000175:diagnosis / Q000209:etiology*; D016896:Treatment Outcome
chemical_list: D000978:Antiparkinson Agents; D050071:Bone Density Conservation Agents
keywords: Parkinson's disease; fracture; odontoid; older people; osteoporosis