scholarly journals Bilateral atypical femoral subtrochanteric fractures in a premenopausal patient receiving prolonged bisphosphonate therapy: evidence of severely suppressed bone turnover

Author(s):  
N Kondo
2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Kensaku Abe ◽  
Hiroaki Kimura ◽  
Norio Yamamoto ◽  
Shingo Shimozaki ◽  
Takashi Higuchi ◽  
...  

Abstract Background Atypical fractures may occur due to the combined effect of severely suppressed bone turnover (SSBT) caused by long-term bisphosphonate treatment and chronic repetitive bone microdamage. Atypical fracture of the ulna due to SSBT is a rare entity; there is no standardized treatment strategy for this condition. We successfully treated a patient with atypical fracture of the ulna. Herein, we present this patient, review the relevant literature, and discuss the treatment strategy. Case presentation An 84-year-old woman presented with atypical fracture of the left ulnar shaft due to SSBT. She had a history of bisphosphonate therapy (ibandronate and alendronate) since more than 10 years; her bone turnover was severely suppressed. We performed open reduction and internal fixation (ORIF) using dual plate with some additional treatments. These included drilling and decortication, use of autogenous bone graft, low-intensity pulsed ultrasound (LIPUS) treatment, and administration of teriparatide. Finally, bone union was observed at 11 months after surgery. Conclusions Based on the literature review and our experience with this case, ORIF alone may not be adequate to achieve bone union; drilling, decortication, and use of cancellus bone graft is important to achieve favorable outcomes. Administration of teriparatide and LIPUS may facilitate early bone union, although further studies are required to provide more definitive evidence. Furthermore, ORIF using dual plate may help avoid implant failure owing to the long time required for bone union.


2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Kensaku Abe ◽  
Hiroaki Kimura ◽  
Norio Yamamoto ◽  
Shingo Shimozaki ◽  
Takashi Higuchi ◽  
...  

An amendment to this paper has been published and can be accessed via the original article.


2014 ◽  
Vol 17 (03) ◽  
pp. 1450011
Author(s):  
Myung-Sang Moon ◽  
Ki-Tae Kwon ◽  
Chang-Won Ha ◽  
Sung-Soo Kim ◽  
Sung Sim Kim ◽  
...  

Based on the pharmaco-physiology of the aminobisphosphonates, it could be speculated that bisphosphonates could induce not only the osteopetrotic bone disease because of their selective suppression of osteoclastic activity, but also could affect directly or indirectly the endocrine system, local factors, and also the bone metabolic turnover. Consequently, the bone fragility could be rather produced by long-term aminobisphosphonate therapy. Bisphosphonate-mediated bone disease was labeled by Odvina et al. in 2005 [Odvina CV, Zerwerth JE, Rao DS et al. Severely suppressed bone turnover; a potential complication of alendronate therapy. J Clin Endocrinol Metab 90: 1294–1301, 2005.] as the "severely suppressed bone turnover (SSBT)" on the metabolic turnover basis. However, such definition could contain various drug-induced bone diseases, and did not indicate any particular condition, induced by the bisphosphonate. The term "SSBT" is thought not solely to be based on its histology, and seems rather a clinical term applicable to the various drug-induced bone diseases. Therefore, the current authors attempted to characterize the bisphosphonate-mediated bone disease on the basis of the combined image and histological studies, and finally concluded that the prolonged bisphosphonate therapy could produce an atypical osteomalacic bone disease. (osteosclerosis of osteomalacia) which leads to fragility fracture. It is puzzling as to why malacia rather than petrosis develops in the skeleton.


2008 ◽  
Vol 26 (27) ◽  
pp. 4426-4434 ◽  
Author(s):  
Susan L. Greenspan ◽  
Joel B. Nelson ◽  
Donald L. Trump ◽  
Julie M. Wagner ◽  
Megan E. Miller ◽  
...  

Purpose Androgen-deprivation therapy (ADT) for prostate cancer is associated with bone loss and osteoporotic fractures. Our objective was to examine changes in bone density and turnover with sustained, discontinued, or delayed oral bisphosphonate therapy in men receiving ADT. Patients and Methods A total of 112 men with nonmetastatic prostate cancer receiving ADT were randomly assigned to alendronate 70 mg once weekly or placebo in a double-blind, partial-crossover trial with a second random assignment at year 2 for those who initially received active therapy. Outcomes included bone mineral density and bone turnover markers. Results Men initially randomly assigned to alendronate and randomly reassigned at year 2 to continue had additional bone density gains at the spine (mean, 2.3% ± 0.7) and hip (mean, 1.3% ± 0.5%; both P < .01); those randomly assigned to placebo in year 2 maintained density at the spine and hip but lost (mean, −1.9% ± 0.6%; P < .01) at the forearm. Patients randomly assigned to begin alendronate in year 2 experienced improvements in bone mass at the spine and hip, but experienced less of an increase compared with those who initiated alendronate at baseline. Men receiving alendronate for 2 years experienced a mean 6.7% (± 1.2%) increase at the spine and a 3.2% (± 1.5%) at the hip (both P < .05). Bone turnover remained suppressed. Conclusion Among men with nonmetastatic prostate cancer receiving ADT, once-weekly alendronate improves bone density and decreases turnover. A second year of alendronate provides additional skeletal benefit, whereas discontinuation results in bone loss and increased bone turnover. Delay in bisphosphonate therapy appears detrimental to bone health.


Author(s):  
Stuart H. Ralston

Paget's disease of bone (PDB) affects up to 1% of people of European origin aged 55 years and above. It is characterized by focal abnormalities of bone remodelling which disrupt normal bone architecture, leading to expansion and reduced mechanical strength of affected bones. This can lead to various complications including deformity, fracture, nerve compression syndromes, and osteoarthritis, although many patients are asymptomatic. Genetic factors play a key role in the pathogenesis of PDB. This seems to be mediated by a combination of rare genetic variants which cause familial forms of the disease and common variants which increase susceptibility to environmental triggers. Environmental factors which have been suggested to predispose to PDB include viral infections, calcium and vitamin D deficiency, and excessive mechanical loading of affected bones. The diagnosis can be made by the characteristic changes seen on radiographs, but isotope bone scans are helpful in defining disease extent. Serum alkaline phosphatase levels can be used as a measure of disease activity. Inhibitors of bone resorption are the mainstay of medical management for PDB and bisphosphonates are regarded as the treatment of choice. Bisphosphonates are highly effective at reducing bone turnover in PDB and have been found to heal osteolytic lesions, and normalize bone histology. Although bisphosphonates can improving bone pain caused by elevated bone turnover, most patients require additional therapy to deal with symptoms associated with disease complications. It is currently unclear whether bisphosphonate therapy is effective at preventing complications of PDB.


2016 ◽  
Vol 21 ◽  
pp. 241-249 ◽  
Author(s):  
Ewa Nowacka-Cieciura ◽  
Anna Sadowska ◽  
Marek Pacholczyk ◽  
Andrzej Chmura ◽  
Olga Tronina ◽  
...  

2004 ◽  
Vol 65 (1) ◽  
pp. 304-309 ◽  
Author(s):  
Christoph Schwarz ◽  
Christa Mitterbauer ◽  
Georg Heinze ◽  
Wolfgang Woloszczuk ◽  
Martin Haas ◽  
...  

Bone ◽  
2011 ◽  
Vol 49 (6) ◽  
pp. 1279-1289 ◽  
Author(s):  
Crystal K. Tjhia ◽  
Clarita V. Odvina ◽  
D. Sudhaker Rao ◽  
Susan M. Stover ◽  
Xiang Wang ◽  
...  

2005 ◽  
Vol 90 (3) ◽  
pp. 1294-1301 ◽  
Author(s):  
Clarita V. Odvina ◽  
Joseph E. Zerwekh ◽  
D. Sudhaker Rao ◽  
Naim Maalouf ◽  
Frank A. Gottschalk ◽  
...  

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