Tuberculous spondylitis in the elderly: a potential diagnostic pitfall.

complications are rare. Major textbooks and specialised books on osteoporosis either do not mention spinal cord compression as a complication of senile osteoporosis'-3 or state that it is rare or does not occur." Thus one book states, "Nerve root compression is rare and spinal cord damage does not occur even in the presence ofsevere deformity"5; another that, "Spinal cord compression does not occur and classical root pain is atypical"'; while another does not completely exclude the possibility of paraplegia in stating that, "Radiation of pain down one leg is uncommon and symptoms or signs of spinal cord compression are very rare."4 There was both clinical and radiological support for the diagnosis of metastatic bone disease in both of our patients, with no other differential diagnosis being considered to be likely. Necropsy was expected to confirm this, but pathological and histological examination showed only osteoporosis in each case. It is interesting that both patients were men as the condition is rarer in men, but we cannot propose any explanation for this other than chance. These two cases should alert physicians to the possibility of osteoporotic vertebral collapse as a cause ofspinal cord compression and encourage its mention in future editions of the relevant textbooks.