Kalliopi Lampropoulou-Adamidou1, Symeon Tournis2, Alexia Balanika3, Ioulia Antoniou2, Ioannis P Stathopoulos1, Christos Baltas4, Ioannis K Triantafillopoulos2, Nikolaos A Papaioannou2. 1. 3rd Department of Orthopaedic Surgery, Laboratory for the Research of Musculoskeletal System "Th. Garofalidis", Medical School, University of Athens, General Hospital of Athens KAT, Athens, Greece. 2. Laboratory for the Research of Musculoskeletal System "Th. Garofalidis", Medical School, University of Athens, General Hospital of Athens KAT, Athens, Greece. 3. Computed Tomography Department, General Hospital of Athens "Asklipion Voulas", Athens, Greece. 4. Radiology Imaging Department, General Hospital of Athens "G. Gennimatas", Athens, Greece.
Abstract
OBJECTIVE: Despite the existence of numerous case series, no evidenced-based medical management for atypical fractures associated with bisphosphonate (BP) treatment has been established. DESIGN: We report the outcome of teriparatide (TRP) administration followed by strontium ranelate (SR) in a woman with a complete and an incomplete contralateral atypical fracture of the femoral diaphysis (AFF) associated with BP treatment. The spontaneous complete AFF was managed with intramedullary nailing, discontinuation of BP and initiation TRP. RESULTS: Eleven months later, she suffered a contralateral incomplete AFF. At the completion of the TRP treatment, she had only slight discomfort in the femur with the incomplete AFF. BMD testing revealed increase of 7.61% at the lumbar spine (LS) and 0.8% at the hip. Following TRP, 1-year SR treatment resulted in further BMD increase of 9.2% at the LS and 1.4% in the hip, while she does not report any pain. Bone markers remain within the normal range. CONCLUSION: Our case indicates that sequential therapy with TRP and SR in cases of AFF might be a rational treatment option. However, there is a need for additional information concerning the effect of TRP and SR, given alone or sequentially, in these patients in order to incorporate these drugs into the management of AFF.
OBJECTIVE: Despite the existence of numerous case series, no evidenced-based medical management for atypical fractures associated with bisphosphonate (BP) treatment has been established. DESIGN: We report the outcome of teriparatide (TRP) administration followed by strontium ranelate (SR) in a woman with a complete and an incomplete contralateral atypical fracture of the femoral diaphysis (AFF) associated with BP treatment. The spontaneous complete AFF was managed with intramedullary nailing, discontinuation of BP and initiation TRP. RESULTS: Eleven months later, she suffered a contralateral incomplete AFF. At the completion of the TRP treatment, she had only slight discomfort in the femur with the incomplete AFF. BMD testing revealed increase of 7.61% at the lumbar spine (LS) and 0.8% at the hip. Following TRP, 1-year SR treatment resulted in further BMD increase of 9.2% at the LS and 1.4% in the hip, while she does not report any pain. Bone markers remain within the normal range. CONCLUSION: Our case indicates that sequential therapy with TRP and SR in cases of AFF might be a rational treatment option. However, there is a need for additional information concerning the effect of TRP and SR, given alone or sequentially, in these patients in order to incorporate these drugs into the management of AFF.
Authors: Robert A Adler; Ghada El-Hajj Fuleihan; Douglas C Bauer; Pauline M Camacho; Bart L Clarke; Gregory A Clines; Juliet E Compston; Matthew T Drake; Beatrice J Edwards; Murray J Favus; Susan L Greenspan; Ross McKinney; Robert J Pignolo; Deborah E Sellmeyer Journal: J Bone Miner Res Date: 2016-01 Impact factor: 6.741
Authors: Denise M van de Laarschot; Malachi J McKenna; Bo Abrahamsen; Bente Langdahl; Martine Cohen-Solal; Núria Guañabens; Richard Eastell; Stuart H Ralston; M Carola Zillikens Journal: J Clin Endocrinol Metab Date: 2020-05-01 Impact factor: 5.958