Kun-Hung Lai1,2, Chih-Yung Chiang1,2, Rong-Sen Yang2, Kai-Chiang Yang1,3, Chang-Chin Wu1,2,4. 1. Department of Orthopedics, En Chu Kong Hospital , New Taipei City , Taiwan. 2. Department of Orthopaedic Surgery, National Taiwan University Hospital , Taipei Taiwan. 3. School of Dental Technology, College of Oral Medicine, Taipei Medical University , Taipei , Taiwan. 4. Department of Biomedical Engineering, Yuanpei University of Medical Technology , Hsinchu , Taiwan.
Abstract
Background: Patients with chronic obstructive pulmonary disease have a high prevalence of osteoporosis, and different osteoporosis drugs are used to prevent fractures in these patients. Although the overall incidence of complete or incomplete, atypical femoral fracture (AFF) is low, long-term use of antiresorptive agents is associated with an increased risk of developing AFF. Methods: We present a patient with chronic obstructive pulmonary disease with recurrent symptoms of an incomplete AFF who had been treated with glucocorticoids, and sequentially with alendronate, zoledronic acid, strontium ranelate, raloxifene, denosumab and finally with teriparatide. The first episode occurred before osteoporosis therapies, the second after bisphosphonate treatments, and the third under denosumab. Results: Although her symptoms resolved along with gradually healing of fracture lines after conservative treatment without surgical intervention, progressive varus deformity of the proximal femur may have contributed to recurrence of AFF. Conclusion: Early treatment with anabolic agents and prophylactic fixation of incomplete AFF may alleviate symptoms and prevent recurrences.
Background: Patients with chronic obstructive pulmonary disease have a high prevalence of osteoporosis, and different osteoporosis drugs are used to prevent fractures in these patients. Although the overall incidence of complete or incomplete, atypical femoral fracture (AFF) is low, long-term use of antiresorptive agents is associated with an increased risk of developing AFF. Methods: We present a patient with chronic obstructive pulmonary disease with recurrent symptoms of an incomplete AFF who had been treated with glucocorticoids, and sequentially with alendronate, zoledronic acid, strontium ranelate, raloxifene, denosumab and finally with teriparatide. The first episode occurred before osteoporosis therapies, the second after bisphosphonate treatments, and the third under denosumab. Results: Although her symptoms resolved along with gradually healing of fracture lines after conservative treatment without surgical intervention, progressive varus deformity of the proximal femur may have contributed to recurrence of AFF. Conclusion: Early treatment with anabolic agents and prophylactic fixation of incomplete AFF may alleviate symptoms and prevent recurrences.
Authors: Judith Everts-Graber; Harald Bonel; Daniel Lehmann; Brigitta Gahl; HansJörg Häuselmann; Ueli Studer; Hans-Rudolf Ziswiler; Stephan Reichenbach; Thomas Lehmann Journal: JBMR Plus Date: 2022-09-22