Fighting the Fracture Cascade: Early and Repeated Balloon Kyphoplasty as a Bridge Until the Effects of Osteoporosis Treatment Become Apparent in a Super-Aged Patient

Osteoporotic vertebral compression fractures are common in the elderly and frequently lead to pain, spinal deformity, and decreased activities of daily living (ADL). While balloon kyphoplasty (BKP) is known to provide rapid pain relief and improve mobility, it does not prevent the occurrence of subsequent adjacent vertebral fractures, especially before the therapeutic effects of pharmacologic osteoporosis treatments such as teriparatide become apparent. We report the case of an 87-year-old super-aged female patient who experienced a cascade of five adjacent vertebral fractures within four months. After conservative treatment failed, she underwent BKP for L1 and L4, resulting in immediate pain relief. However, new fractures subsequently occurred at Th12, L2, and L3, each requiring further BKP. Early surgical intervention after each fracture successfully restored mobility and preserved independence in ADL. Over a five-year follow-up period, no new fractures were observed, and spinal alignment was maintained. This case highlights the utility of early and repeated BKP as a bridging strategy until the effects of osteoporosis treatment take hold. Timely, minimally invasive interventions can prevent deterioration of spinal alignment and preserve quality of life in super-aged patients with severe osteoporosis.