[Background] The impact of lifestyle-related disease (LSD) as a risk factor for bone fragility fracture (BFF) in patients with high osteoporotic risks was retrospectively investigated. [Methods] Japanese subjects who were followed up for 8 years or more were recruited. The occurrence and survival rates of BFF during follow up were statistically evaluated with comparison between a patient group who suffered LSD (LSD group) and a patient group who did not (non-LSD group). The hazard ratio of the risk in the LSD group compared to the non-LSD group was evaluated using the Kaplan-Meier survival curve. [Results] A total of 610 patients in the LSD group and 321 in the non-LSD group were included in the study. There was no significant difference of T-score of either the lumbar spine or the femoral neck between the two groups. The survival rate after BFF occurrence in the non-LSD group was significantly higher compared to the LSD group. In the LSD group, a significant risk factor that contributed the occurrence of an incident of BFF was musculoskeletal ambulation disability symptom complex (MADS). After excluding patients with MADS, the hazard ratio of the LSD group compared to the non-LSD group was evaluated using cox regression analysis. For 426 of the LSD and 308 of the non-LSD group patients, risk ratio was 2.28 in the LSD group compared to the non-LSD group with 0.0006 of p-value. [Conclusions] These results suggested that LSD is an independent risk factor for BFF.

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A 91-year-old woman presented to our emergency room with a complaint of left-sided chest pain and difficulty walking after a backward fall. After admission, the cause remained unidentified. She described the painful area by rubbing back and forth around the left costal region, but no tenderness was observed. The fall was the trigger, and she complained of banded pain at the 7th to 8th thoracic vertebral level on dermatome, suggesting a nerve root symptom. A fracture of the eighth thoracic vertebra was found on magnetic resonance imaging (MRI). A paraspinal nerve block was performed and her pain improved. She is now able to walk. Thoracic vertebral body fractures rarely cause left-sided chest pain. Clinical reasoning based on careful history-taking and physical examination is important for diagnosis. If the diagnosis cannot be made using radiography or computed tomography, MRI should be considered.

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Acquired factor V (FV) deficiency is characterized by bleeding tendency owing to the development of FV inhibitors. We encountered a case of this disease in a 90-year-old male patient who had been taking warfarin for more than 10 years. He had received antibiotic therapy for a urinary tract infection and developed an FV inhibitor. After normalization of his coagulation function, warfarin re-administration reduced FV coagulation activity. Warfarin was the causative drug for the development of the FV inhibitor. Acquired coagulation factor deficiency should be considered when both the prothrombin time and activated partial thromboplastin time are prolonged during warfarin therapy.

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There are few reports on fulminant Clostridium difficile infection (CDI) in patients on dialysis with no history of antibiotic use. The patient was a 66-year-old woman with a 15-year history of dialysis due to end-stage renal failure. She was diagnosed with fulminant CDI, but her general condition improved with conservative treatment. Fulminant CDI has a high fatality rate, even with surgical treatment. Here, we describe a case of fulminant Clostridium difficile enteritis during dialysis, with no history of antibiotic use, in which a favorable survival outcome was achieved with conservative treatment.

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