Atypical Fracture of Proximal Ulna Associated with Prolonged Bisphosphonate Therapy Managed with Nonoperative Treatment: A Case Report and Literature Review

Prolonged bisphosphonate (BP) treatment is associated with some complications, such as atypical femoral fractures (AFFs). Recent studies showed that atypical fractures also occurred in other bones, especially in the atypical fracture of the proximal ulna (AFPU). Although, AFPUs frequently share the same characteristics of atypical fractures as AFFs, such as fracture configuration and high risk of non-union, there is still limited evidence of the role of non-operative treatment in AFPU. The aim of the present study was to present an interesting case involving an 80-year-old female presented with non-displaced AFPU after receiving long-term BP medication and had been treated with a conservative method for 2.5 years, and to review the literature regarding the available AFPU treatment options. To the best of the authors’ knowledge, the present case report introduced new insight of the outcome of non-operative treatment for AFPU. Keywords: Non-displaced fracture; Ulna fracture; Long-term bisphosphonates; Conservative treatment; Nonunion; Osteoporosis

Atypical fractures secondary to bisphosphonate therapy: A case series and pictorial review

Osteoporosis is a ubiquitous and chronic process that affects an increasing number of people each year. Various forms of treatment are currently used including bisphosphonates which have been linked to atypical fractures of the femur. We present a case series of eight osteoporosis patients who developed atypical femoral fractures, while on bisphosphonate therapy. This pictorial review aims to increase awareness of bisphosphonate-related atypical fractures, discuss the current literature recommendations, and provide clear learning points from each case-based discussion.

Current concept of stress fractures with an additional category of atypical fractures: a perspective review with representative images

Stress fractures have traditionally been classified into three categories: fatigue fractures due to overuse of bone with normal elastic resistance; insufficiency fractures due to everyday physiological stress on fragile bone with poor elastic resistance; and pathologic fractures due to bone weakness involving tumors. The concept of atypical fractures has emerged and is considered a type of stress fracture. However, there has been some inconsistency in interpretation when using the traditional classification of stress fractures, and atypical femoral fractures (AFFs) can potentially be classified into subtypes: “typical” AFFs involving bone turnover suppression due to specific drugs (e.g. bisphosphonates) and fragility fractures of the bowed femoral shaft. In this article, the classification of stress fractures is redefined with the addition of atypical fractures as a fourth category, in which biological activity for fracture healing is absent, to promote consistent understanding and interpretation of clinical conditions involving stress fractures.

Actual features of express diagnostic of acetabular fractures. Part III. Atypical fractures diagnostic algorithm. Associated local injuries

Authors shows atypical fracture patterns and rational algorithm for express diagnostic of this fractures. Associated local injuries are described.

A Suspicious Atypical Fracture of 5th Metatarsal Bone: A Case Report

Category: Trauma Introduction/Purpose: Long-term usage of bisphosphonate can severely suppress bone turnover and alter bone mechanical properties, thereby resulting in atypical fractures that mainly occur at the femur.We present a rare case of suspicious atypical fracture of the metatarsal bone. Methods: A 63-year-old woman presented to our clinic with a primary complain of a one-week history of pain in her right foot. The patient had no history of trauma to the right foot and denied any strenuous activity. She experienced lateral foot pain while walking within her home. She was on alendronate therapy for osteoporosis for a decade. X ray and CT examination revealed a fifth metatarsal fracture whose features were compatible with those of atypical femoral fractures (Figure 1). Results: The patient was advised to discontinue alendronate and underwent percutaneous surgical fixation of the fracture via a proximal approach using a 4.0-mm half-threaded cannulated screw. Postoperatively, a short leg cast was created and the patients performed non-weight bearing ambulation until the cast was removed at the sixth postoperative week. Radiography in the sixth postoperative week revealed callus formation. Conclusion: Our findings suggest that physicians must keep in mind that atypical fractures could possibly occur at bones other than the femur.

Treatment of Atypical Fracture of the Ulnar Diaphysis by Open Reduction and Internal Fixation with Teriparatide

Atypical fractures commonly arise in the subtrochanteric region or the femoral shaft, whereas those of the upper extremities are rare. Only 15 fractures in 13 patients have been described in the English literature. The management of such fractures has not been established. We describe a patient with an atypical fracture of the ulnar diaphysis, which required revision surgery to achieve the union of the fracture site. Teriparatide together with low-intensity pulsed ultrasound contributed to bone healing. Further studies are needed to determine the optimal strategy for treating atypical fractures of the ulna.

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.