ISSN: 1301-2193 E-ISSN: 1308-9846
  • Turkish Journal of
    Endocrinology and Metabolism
CASE REPORT

Bilateral Atypical Femur Fracture in a Patient Under Bisphosphonate Treatment
Bifosfonat ile Tedavi Olan Hastada Çift Taraflı Atipik Femur Kırığı
Received Date : 25 Dec 2018
Accepted Date : 19 Jun 2019
Doi: 10.25179/tjem.2018-64415 - Makale Dili: EN
Turk J Endocrinol Metab 2019;23:187-190
Bu makale, CC BY-NC-SA altında lisanslanmış açık erişim bir makaledir.
ABSTRACT
Osteoporosis is a systemic skeletal disease that affects most of the elderly people. Bisphosphonate is an effective anti-resorptive drug widely used for the prevention and treatment of osteoporosis. However, recent evidence has linked longterm bisphosphonate use with an atypical fracture. We report a case of a 79-year-old woman who had been on bisphosphonate treatment for eight years and presented with bilateral femur diaphyseal fractures occurring within an interval of a few months. The physicians must consider the possibility of atypical fractures with the fresh onset of groin or mid-thigh pain in patients who have been on bisphosphonate therapy, particularly for more than five years.
ÖZET
Osteoporoz, birçok yaşlı hastayı etkileyen sistemik bir iskelet hastalığıdır. Bifosfonatlar osteoporozun önlenmesinde ve tedavisinde kullanılan etkin bir anti-rezorptif ilaçtır. Son dönem kanıtlar, uzun dönem bifosfonat kullanımını atipik kırıklarla ilişkilendirmiştir. Bu çalışmada, sekiz yıldır bifosfonat tedavisi alan, birkaç ay aralıklarla bilateral femur diyafiz kırığı geçiren, 79 yaşındaki kadın olgunun sunulması amaçlanmıştır. Tüm hekimler; yeni başlayan kasık veya orta uyluk ağrılı hastalarda, özellikle beş yıldan uzun süredir bifosfonat kullanımı var ise; atipik kırık ihtimalinin olduğunu akılda tutmalıdır.
KAYNAKLAR
  1. Consensus development conference: diagnosis, prophylaxis, and treatment of osteoporosis. Am J Med. 1993;94:646-650. [Crossref] [PubMed]
  2. Black DM, Cummings SR, Karpf DB, Cauley JA, Thompson DE, Nevitt MC, Bauer DC, Genant HK, Haskell WL, Marcus R, Ott SM, Torner JC, Quandt SA, Reiss TF, Ensrud KE. Randomised trial of effect of alendronate on risk of fracture in women with existing vertebral fractures. Fracture Intervention Trial Research Group. Lancet. 1996;348:1535-1541. [Crossref] [PubMed]
  3. Harris ST, Watts NB, Genant HK, McKeever CD, Hangartner T, Keller M, Chesnut CH 3rd, Brown J, Eriksen EF, Hoseyni MS, Axelrod DW, Miller PD. Effects of risedronate treatment on vertebral and nonvertebral fractures in women with postmenopausal osteoporosis: a randomized controlled trial. Vertebral Efficacy with Risedronate Therapy (VERT) Study Group. JAMA. 1999;282:1344-1352. [Crossref] [PubMed]
  4. Freemantle N, Cooper C, Diez-Perez A, Gitlin M, Radcliffe H, Shepherd S, Roux C. Results of indirect and mixed treatment comparison of fracture efficacy for osteoporosis treatments: a meta-analysis. Osteoporos Int. 2013;24:209-217. [Crossref] [PubMed] [PMC]
  5. Gedmintas L, Solomon DH, Kim SC. Bisphosphonates and risk of subtrochanteric, femoral shaft, and atypical femur fracture: a systematic review and meta-analysis. J Bone Miner Res. 2013;28:1729-1737. [Crossref] [PubMed] [PMC]
  6. Compston J, Bowring C, Cooper A, Cooper C, Davies C, Francis R, Kanis JA, Marsh D, McCloskey EV, Reid DM, Selby P; National Osteoporosis Guideline Group. Diagnosis and management of osteoporosis in postmenopausal women and older men in the UK: National Osteoporosis Guideline Group (NOGG) update 2013. Maturitas. 2013;75:392-396. [Crossref] [PubMed]
  7. Pfeifer M, Begerow B, Minne HW, Schlotthauer T, Pospeschill M, Scholz M, Lazarescu AD, Pollähne W. Vitamin D status, trunk muscle strength, body sway, falls, and fractures among 237 postmenopausal women with osteoporosis. Exp Clin Endocrinol Diabetes. 2001;109:87-92. [Crossref] [PubMed]
  8. American Geriatrics Society Workgroup on Vitamin D Supplementation for Older Adults. Recommendations abstracted from the American Geriatrics Society Consensus Statement on vitamin d for prevention of falls and their consequences. J Am Geriatr Soc. 2014;62:147-152. [Crossref] [PubMed]
  9. Chalmers J. Subtrochanteric fractures in osteomalacia. J Bone Joint Surg Br. 1970;52:509-513. [Crossref] [PubMed]
  10. Donnelly E, Saleh A, Unnanuntana A, Lane JM. Atypical femoral fractures: epidemiology, etiology, and patient management. Curr Opin Support Palliat Care. 2012;6:348-354. [Crossref] [PubMed] [PMC]
  11. Khan AA, Kaiser S. Atypical femoral fracture. CMAJ. 2017;189:E542. [PubMed] [PMC]
  12. Gomberg SJ, Wustrack RL, Napoli N, Arnaud CD, Black DM. Teriparatide, vitamin D, and calcium healed bilateral subtrochanteric stres fractures in a postmenopausal woman with a 13-year history of continuous alendronate therapy. J Clin Endocrinol Metab. 2011;96:1627-1632. [Crossref] [PubMed]
  13. Park-Wyllie LY, Mamdani MM, Juurlink DN, Hawker GA, Gunraj N, Austin PC, Whelan DB, Weiler PJ, Laupacis A. Bisphosphonate use and the risk of subtrochanteric or femoral shaft fractures in older women. JAMA. 2011;305:783-789. [Crossref] [PubMed]
  14. Abrahamsen B, Eiken P, Eastell R. Cumulative alendronate dose and the long-term absolute risk of subtrochanteric and diaphyseal femur fractures: a register-based national cohort analysis. J Clin Endocrinol Metab. 2010;95:5258-5265. [Crossref] [PubMed] [PMC]
  15. Odvina CV, Zerwekh JE, Rao DS, Maalouf N, Gottschalk FA, Pak CY. Severely suppressed bone turnover: a potential complication of alendronate therapy. J Clin Endocrinol Metab. 2005;90:1294-1301. [Crossref] [PubMed]
  16. Shane E, Burr D, Ebeling PR, Abrahamsen B, Adler RA, Brown TD, Cheung AM, Cosman F, Curtis JR, Dell R, Dempster D, Einhorn TA, Genant HK, Geusens P, Klaushofer K, Koval K, Lane JM, McKiernan F, McKinney R, Ng A, Nieves J, O'Keefe R, Papapoulos S, Sen HT, van der Meulen MC, Weinstein RS, Whyte M. Atypical subtrochanteric and diaphyseal femoral fractures: report of a task force of the American Society for Bone and Mineral Research. J Bone Miner Res. 2010;25:2267-2294. [Crossref] [PubMed]
  17. Holick MF. Vitamin D deficiency. N Engl J Med. 2007;357:266-281. [Crossref] [PubMed]
  18. Hekimsoy Z, Dinç G, Kafesçiler S, Onur E, Güvenç Y, Pala T, Güçlü F, Ozmen B. Vitamin D status among adults in the Aegean region of Turkey. BMC Public Health. 2010;10:782. [Crossref] [PubMed] [PMC]
  19. Erkal MZ, Wilde J, Bilgin Y, Akinci A, Demir E, Bödeker RH, Mann M, Bretzel RG, Stracke H, Holick MF. High prevalence of vitamin D deficiency, secondary hyperparathyroidism and generalized bone pain in Turkish immigrants in Germany: identification of risk factors. Osteoporos Int. 2006;17:1133-1140. [Crossref] [PubMed]
  20. Atli T, Gullu S, Uysal AR, Erdogan G. The prevalence of vitamin D deficiency and effects of ultraviolet light on vitamin D levels in elderly Turkish population. Arch Gerontol Geriatr. 2005;40:53-60. [Crossref] [PubMed]