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.

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.

Wide-awake local anesthesia has many advantages. We describe a new method to use wide-awake local anesthesia with more flexibility. A 32-year-old man with a severe right-hand contracture after an iatrogenic tourniquet accident during an anterolateral thigh flap for a partial hand amputation underwent contracture release using external fixation after proximal row carpectomy and subsequent tenolysis. We performed most of the tenolysis procedure under general anesthesia and the final stage with an intraoperative assessment of active finger movement and dissection under local anesthesia. He regained his grip strength 2.5 years post-injury. General anesthesia is useful to treat a surgical site with extensive hard scars, whereas local anesthesia is useful for adjusting tension in an awake patient. The indication for wide-awake surgery is yet to be established; our method of combining general and local anesthesia in the tenolysis procedure illustrates the possibilities in expanding this method.
Adult ; Anesthesia, General ; Anesthesia, Local ; Brain Neoplasms ; Contracture/surgery* ; Dissection ; External Fixators ; Fracture Fixation ; Humans ; Male ; Wakefulness