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

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.


2019 ◽  
Vol 11 (2) ◽  
pp. 69
Author(s):  
Rangga Rawung ◽  
Chita Moningkey

Abstrak: Infeksi pada tulang dan sendi masih merupakan kasus yang menantang. Kondisi ini memberikan banyak penyulit baik kepada dokter maupun pasien. Meski terapi antibiotika dilaporkan memberikan hasil yang memuaskan pada banyak kasus infeksi, tidak demikian pada kasus infeksi tulang dan sendi. Hal ini berhubungan dengan struktur anatomi dan fisiologi dari tulang. Diperlukan sebuah strategi tata laksana yang baik untuk mencapai hasil yang optimal. Prinsip dasar yang utama dalam mencapai pengobatan yang optimal ialah penegakan diagnosis awal yang tepat, termasuk di dalamnya proses investigasi pemeriksaan mikrobiologi dan patologi. Diperlukan pengertian dasar serta pengenalan kembali anatomi, fisiologi, patofisiologi, dan tata laksana terkini tentang osteomielitis untuk mencapai tatalaksana yang optimal.Kata kunci: diagnosis dan tata laksana osteomielitisAbstract: Infection in bone and joint is still a challenging case. It gives a lot of problems and frustration to the physician and patient. The successful antibiotic therapy in most infectious diseases is abortive to achieve in bone and joint infections because the different characteristic in anatomy and physiology of these structures. Therefore, treatment strategy, including non operative and operative techniques is required to deal with such conditions. The basic principle to achieve a successful management of osteomyelitis in general is correct initial diagnosis including investigation for microbiological and pathological examinations to allow the proper and long term lasting therapy of antibiotic. For that reason, it is required to have the basic understanding in dealing with this issue, obvious and updated. It is commited to review the pathophysiology, the diagnosis, and the management of osteomyelitis in order to presents basic facilities in dealing with osteomyelitis.Keywords: osteomyelitis diagnosis and management


2015 ◽  
Vol 1 (1) ◽  
Author(s):  
Sandrine Malochet Guinamand

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.


2019 ◽  
Vol 12 (7) ◽  
pp. e229366 ◽  
Author(s):  
Juan Tan ◽  
Hiroshige Sano ◽  
Kenneth Poole

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.


2019 ◽  
Vol 22 (2) ◽  
pp. 147-154
Author(s):  
Alessandra De Carvalho Moreira ◽  
Jhenifer Rodrigues Silva ◽  
Renata De Paula Samico ◽  
Gabriela Nogueira de Melo Nishioka ◽  
Renato Sussumu Nishioka

Objetivo: Bio-Oss is a xenogene bone graft in which all organic components are removed while retaining their natural mineral architecture. Therefore, the aim of this study was to evaluate, through a literature review, the benefits of using Bio-Oss for tissue regenerative treatment prior to implant placement. Material and Methods: a search was performed in Pubmed (Medline) in order to identify articles published in English between January 1, 2000 and June 31, 2018, where the Bio-Oss graft was used prior to implantation of implants in humans. A total of 40 studies were selected for detailed analysis. From this analysis, 18 articles were identified for inclusion in this review. Results: the articles analyzed in the review showed several beneficial effects of this xenograft, such as: positive osteoconductive properties, recovery of bone heights at sites with severe atrophies, slow xenograft reabsorption suggesting long term stability, survival rates and success of implants placed in grafted sites ranging from 91 to 100% in several studies. Conclusion: the use of bio-oss as a bone substitute is a viable alternative in the placement before dental implants, being used in clinical practice and with proved efficacy in several studies, due to its similarity with the bone and its high level of osteoconductivity.KeywordsBio-Oss; Bone Graft; Implants.


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