Antiresorptive-associated spontaneous fractures of both tibiae, followed by an atypical femur fracture during the sequential treatment with alendronate, denosumab then teriparatide

A 35-year-old man with juvenile idiopathic arthritis since childhood presented with bilateral atypical tibial fractures, followed by a later, single atypical fracture of the femur. The fractures were associated with 6 years of oral alendronate treatment immediately followed by subcutaneous denosumab therapy and later teriparatide therapy for osteoporosis. Atypical fractures are known to occur in the femur following bisphosphonate therapy; however, there are only a few documented cases of atypical fractures in the tibia. Our case highlights a rare but serious complication of a commonly prescribed antiresorptive agent. It also shows that teriparatide, while helpful in increasing bone mass, does not fully prevent the development of atypical fractures. Careful investigation should be considered in patients on long-term antiresorptive therapy presenting with bony tenderness to exclude an atypical fracture.

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Acute Nontraumatic Clavicle Fracture Associated with Long-Term Bisphosphonate Therapy

Case Reports in Orthopedics ◽

10.1155/2014/986718 ◽

2014 ◽

Vol 2014 ◽

pp. 1-3 ◽

Cited By ~ 3

Author(s):

Shen Hwa Vun ◽

Yahya Husami ◽

Sajan Shareef ◽

Diane Bramley

Keyword(s):

Clavicle Fracture ◽

Critical Evaluation ◽

Osteonecrosis Of The Jaw ◽

Bisphosphonate Therapy ◽

Low Energy ◽

Insufficiency Fractures ◽

Atypical Fractures

Cases of osteonecrosis of the jaw, insufficiency fractures and atypical low energy or atraumatic fractures of pelvis, femur (subtrochanteric/mid-shaft/distal-third), tibia, fibula, metatarsal, humerus, and ulna related to long-term bisphosphonate therapy have been reported in the literature. We present the case of an acute nontraumatic clavicle fracture, associated with long-term bisphosphonate therapy, which to our knowledge has not been reported previously. This case highlights the need of critical evaluation of patients with atypical fractures during long-term bisphosphonate therapy.

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Atypical Insufficiency Fractures Associated with Long-Term Bisphosphonate Therapy: 3 Case Reports

Journal of Bone Biology and Osteoporosis ◽

10.18314/jbo.v1i1.45 ◽

2015 ◽

Vol 1 (1) ◽

Author(s):

Sandrine Malochet Guinamand

Keyword(s):

Case Reports ◽

Femoral Fractures ◽

Bisphosphonate Therapy ◽

Fracture Site ◽

Atypical Fracture ◽

Mineral Research ◽

The Third ◽

First Case ◽

The Right

Atypical femoral fractures as defined by the American Society for Bone and Mineral Research (ASBMR) are linked with long-term bisphosphonate therapy. We report the cases of 3 patients treated with bisphosphonates, and presenting non femoral atypical fracture. Our first patient presented with a series of fractures after being treated with risedronate: the left tibia, bilateral tibial plateau successively, the left femoral and tibial metaphysis, the right tibia and calcaneus, the left talus, and the left talar dome. The second patient had been taking alendronate and presented with a spontaneous fracture of the spine of the left scapula. The third patient had been treated with alendronate and presented with a fracture of the upper right tibial diaphysis with an unusual oblique orientation. These fractures could be suggestive of bisphosphonate therapy failure or stress fractures. However, the number of fractures in our first case, the fracture site in the second and the fracture line orientation in the third brings to mind the hypothesis of atypical non femoral fractures associated with bisphosphonate therapy. We therefore suggest the possibility of a new type of atypical fracture in patients treated with bisphosphonates, and whose causal relationship with bisphosphonates is even more difficult to demonstrate.

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Treatment strategy for atypical ulnar fracture due to severely suppressed bone turnover caused by long-term bisphosphonate therapy: a case report and literature review

BMC Musculoskeletal Disorders ◽

10.1186/s12891-020-03824-y ◽

2020 ◽

Vol 21 (1) ◽

Cited By ~ 2

Author(s):

Kensaku Abe ◽

Hiroaki Kimura ◽

Norio Yamamoto ◽

Shingo Shimozaki ◽

Takashi Higuchi ◽

...

Keyword(s):

Literature Review ◽

Bone Turnover ◽

Bone Graft ◽

Treatment Strategy ◽

Bisphosphonate Therapy ◽

Bone Union ◽

Atypical Fracture ◽

Dual Plate ◽

Severely Suppressed Bone Turnover

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.

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Follow-Up of Atypical Fractures Associated with Long-Term Bisphosphonate Therapy: A Case Series

10.1210/endo-meetings.2011.part1.p10.p1-232 ◽

2011 ◽

pp. P1-232-P1-232

Author(s):

Francisco Antonio Padilla ◽

Ansu Varughese Joy ◽

Pamela Taxel ◽

Faryal Mirza ◽

Lisanne Cirullo

Keyword(s):

Case Series ◽

Bisphosphonate Therapy ◽

Atypical Fractures

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Bone Structure and Turnover Status in Postmenopausal Women with Atypical Femur Fracture After Prolonged Bisphosphonate Therapy

Calcified Tissue International ◽

10.1007/s00223-016-0223-6 ◽

2016 ◽

Vol 100 (3) ◽

pp. 235-243 ◽

Cited By ~ 9

Author(s):

Shijing Qiu ◽

George W. Divine ◽

Saroj Palnitkar ◽

Pooja Kulkarni ◽

Trent S. Guthrie ◽

...

Keyword(s):

Postmenopausal Women ◽

Bone Structure ◽

Femur Fracture ◽

Bisphosphonate Therapy ◽

Atypical Femur Fracture

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Long-Term Alendronate Use Not without Consequences?

International Journal of Rheumatology ◽

10.1155/2009/253432 ◽

2009 ◽

Vol 2009 ◽

pp. 1-6 ◽

Cited By ~ 9

Author(s):

M. P. Somford ◽

G. F. A. E. Geurts ◽

J. W. A. M. den Teuling ◽

B. J. W. Thomassen ◽

W. F. Draijer

Keyword(s):

Patient Group ◽

Stress Fracture ◽

Side Effect ◽

Femur Fracture ◽

Bisphosphonate Therapy ◽

Lateral Side ◽

Cortical Thickening ◽

Specific Patient ◽

Femur Fractures

A previously unknown side effect of biphosphonate use is emerging. In a specific patient group on long term biphosphonate therapy stress femur fractures seem to occur. The typical presentation consists of prodromal pain in the affected leg and/or a discrete cortical thickening on the lateral side of the femur in conventional radiological examination or the presentation with a spontaneous transverse subtrochanteric femur with typical features. We present three cases of this stress fracture in patients on bisphosphonate therapy. One of these patients suffered a bilateral femur fracture of the same type. In our opinion, in patients on bisphosphonate therapy who present with a spontaneous femur fracture, seizing therapy is advisable. In bilateral cases preventive nailing should be considered.

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