Atypical fracture of the femur in a patient with postmenopausal osteoporosis after four injections of zoledronic acid
- Authors: Gladkova E.N.1,2, Lesnyak O.M.1
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Affiliations:
- North-Western State Medical University named after I.I. Mechnikov
- Clinical Rheumatological Hospital No. 25
- Issue: Vol 26, No 1 (2022)
- Pages: 27-32
- Section: Case report
- Submitted: 17.02.2022
- Accepted: 03.03.2022
- Published: 29.04.2022
- URL: https://journals.eco-vector.com/RFD/article/view/100999
- DOI: https://doi.org/10.17816/RFD100999
- ID: 100999
Cite item
Abstract
Bisphosphonates are one of the most effective medications widely used in the treatment of osteoporosis. In the last 15 years, descriptions, and observations of unusual low-energy femoral fractures with atypical localization for osteoporosis after prolonged use of these drugs have been published.
A 78-year-old patient applied to the osteoporosis center. She received parenteral bisphosphonate therapy for severe osteoporosis for 4 years. In 2017, a spontaneous fracture of the middle third of the femoral shaft was registered (the fracture occurred while walking). Regarding the fracture, metal osteosynthesis with a plate was performed. Subsequently, there was a delayed consolidation of the fracture with the formation of a false joint and the need for repeated surgical intervention. Examination of the patient revealed vitamin D deficiency, and significant negative trend in densitometry.
A feature of this case is poor fracture consolidation and long-term uncompensated vitamin D deficiency. Physicians should be aware of this rare but serious complication of bisphosphonate therapy, as it requires discontinuation of antiresorptive drugs and the appointment of bone anabolic therapy for osteoporosis, which, in addition to treating the underlying disease, also promotes consolidation fracture.
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About the authors
Elena N. Gladkova
North-Western State Medical University named after I.I. Mechnikov; Clinical Rheumatological Hospital No. 25
Author for correspondence.
Email: gen4605@mail.ru
ORCID iD: 0000-0002-6689-6941
SPIN-code: 6535-4153
MD, Cand. Sci. (Med.), Assistant Lecturer
Russian Federation, Saint Petersburg; Saint PetersburgOlga M. Lesnyak
North-Western State Medical University named after I.I. Mechnikov
Email: olga.m.lesnyak@yandex.ru
ORCID iD: 0000-0002-0143-0614
SPIN-code: 6432-4188
Scopus Author ID: 56769681100
ResearcherId: J-5512-2013
MD, Dr. Sci. (Med.), Professor
Russian Federation, Saint PetersburgReferences
- Russell RG. Bisphosphonates: the first 40 years. Bone. 2011;49(1):2–19. doi: 10.1016/j.bone.2011.04.022
- Girgis CM, Seibel MJ. Bisphosphonate use and femoral fractures in older women. JAMA. 2011;305(20):2068; author reply 2069. doi: 10.1001/jama.2011.673
- Park-Wyllie LY, Mamdani MM, Juurlink DN, et al. Bisphosphonate use and the risk of subtrochanteric or femoral shaft fractures in older women. JAMA. 2011;305(8):783–789. doi: 10.1001/jama.2011.190
- Black DM, Kelly MP, Genant HK, et al. Bisphosphonates and fractures of the subtrochanteric or diaphyseal femur. N Engl J Med. 2010;362(19):1761–1771. doi: 10.1056/NEJMoa1001086
- Neviaser AS, Lane JM, Lenart BA, et al. Low-energy femoral shaft fractures associated with alendronate use. J Orthop Trauma. 2008;22(5):346–350. doi: 10.1097/BOT.0b013e318172841c
- Odvina CV, Zerwekh JE, Rao DS, et al. Severely suppressed bone turnover: a potential complication of alendronate therapy. J Clin Endocrinol Metab. 2005;90(3):1294–1301. doi: 10.1210/jc.2004-0952
- Schilcher J, Aspenberg P. Incidence of stress fractures of the femoral shaft in women treated with bisphosphonate. Acta Orthop. 2009;80(4):413–415. doi: 10.3109/17453670903139914
- Shane E, Burr D, Abrahamsen B, et al. Atypical subtrochanteric and diaphyseal femoral fractures: Second report of a task force of the American Society for Bone and Mineral Research. J Bone Miner Res.2014;29(1):1–23. doi: 10.1002/jbmr.1998
- Abrahamsen B, Eiken P, Eastell R. Subtrochanteric and diaphyseal femur fractures in patients treated with alendronate: a register-based national cohort study. J Bone Miner Res. 2009;24(6):1095–1102. doi: 10.1359/jbmr.081247
- Nieves JW, Bilezikian JP, Lane JM, et al. Fragility fractures of the hip and femur: incidence and patient characteristics. Osteoporos Int. 2010;21(3):399–408. doi: 10.1007/s00198-009-0962-6
- Maman E, Briot K, Roux C. Atypical femoral fracture in a 51-year-old woman: Revealing a hypophosphatasia. Joint Bone Spine. 2016;83(3):346–348. doi: 10.1016/j.jbspin.2015.10.009
- Lim SJ, Yeo I, Yoon PW, et al. Incidence, risk factors, and fracture healing of atypical femoral fractures: a multicenter case-control study. Osteoporos Int. 2018;29(11):2427–2435. doi: 10.1007/s00198-018-4640-4
- Adler RA, El-Hajj Fuleihan G, Bauer DC, et al. Managing osteoporosis in patients on long-term bisphosphonate treatment: report of a task force of the American Society for Bone and Mineral Research. J Bone Miner Res. 2016;31(1):16–35. doi: 10.1002/jbmr.2708
- Zotkina KE, Lesnyak OM, Kochish AYu, Sushkov IV. A case of atypical femur fracture during long-term treatment with bisphosphonates in patient with postmenopausal osteoporosis. Osteoporosis and Bone Diseases. 2019;22(1):18–23. (In Russ.). doi: 10.14341/osteo10286
- Buklemishev YuV, Rodionova SS, Krivorotko MS. Difficulties in treatment of atypical femoral fractures (clinical case). Osteoporosis and Bone Diseases. 2020;23(1):62. (In Russ.)