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Spontaneous Incomplete transverse subtrochanteric femoral fracture with cortical thickening possibly secondary to risedronate use: a case report

INTRODUCTION: Osteoporosis is an asymptomatic disease characterized by bone weakening and predisposition to fragility (insufficiency) fractures and can have devastating effects on individual life and great financial impact on the economy. Bisphosphonates are used worldwide for the primary and second...

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Autores principales: Alfahad, Anas, Thet, Ei Mon, Radwan, Fawzy, Sudhakar, Joe, Nini, Khin, Tachtatzis, Phaedra
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2012
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3459800/
https://www.ncbi.nlm.nih.gov/pubmed/22943389
http://dx.doi.org/10.1186/1752-1947-6-272
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author Alfahad, Anas
Thet, Ei Mon
Radwan, Fawzy
Sudhakar, Joe
Nini, Khin
Tachtatzis, Phaedra
author_facet Alfahad, Anas
Thet, Ei Mon
Radwan, Fawzy
Sudhakar, Joe
Nini, Khin
Tachtatzis, Phaedra
author_sort Alfahad, Anas
collection PubMed
description INTRODUCTION: Osteoporosis is an asymptomatic disease characterized by bone weakening and predisposition to fragility (insufficiency) fractures and can have devastating effects on individual life and great financial impact on the economy. Bisphosphonates are used worldwide for the primary and secondary prevention of osteoporotic fractures. However, increasing evidence raises concern that bisphosphonates can be associated with atypical fractures. CASE PRESENTATION: A 65-year-old Caucasian woman on long-term steroid treatment for polymyalgia rheumatica was admitted with severe and constant pain in the right hip, radiating to the right knee. She had a history of steroid-induced osteoporosis, for which she was started on risedronate four years earlier. She had no history of trauma. Her blood results were unremarkable. Her X-rays confirmed that she had an incomplete right subtrochanteric femoral fracture. A bone scan confirmed the diagnosis and also ruled out any other associated fractures. Our patient successfully underwent internal nail fixation of the fracture. She was reviewed by a rheumatology team, which stopped the risedronate. She was started on treatment with denosumab injection. CONCLUSIONS: Previous case series have reported that long-term bisphosphonate use is associated with atypical fractures of the femur, and certain criteria have been established to help identify such rare fractures. Delayed union or non-union is expected in such fractures following definitive orthopedic treatment because of the long half life of bisphosphonates. In this case report, we try to raise questions related to this important subject, like the duration and safety of bisphosphonate use and the alternative medications used in osteoporosis in this rare condition. We consider this case report not only interesting but also important and unusual because it is about a patient who developed a potentially rare and serious side effect of long-term bisphosphonate use, estimated to affect 2.3 in every 10,000 patients, and who presented with a pelvic X-ray that showed the characteristic features of atypical fractures secondary to risedronate use. In addition, most of the documented cases have been associated with many years of bisphosphonate use whereas our patient had been on risedronate for only four years.
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spelling pubmed-34598002012-09-28 Spontaneous Incomplete transverse subtrochanteric femoral fracture with cortical thickening possibly secondary to risedronate use: a case report Alfahad, Anas Thet, Ei Mon Radwan, Fawzy Sudhakar, Joe Nini, Khin Tachtatzis, Phaedra J Med Case Rep Case Report INTRODUCTION: Osteoporosis is an asymptomatic disease characterized by bone weakening and predisposition to fragility (insufficiency) fractures and can have devastating effects on individual life and great financial impact on the economy. Bisphosphonates are used worldwide for the primary and secondary prevention of osteoporotic fractures. However, increasing evidence raises concern that bisphosphonates can be associated with atypical fractures. CASE PRESENTATION: A 65-year-old Caucasian woman on long-term steroid treatment for polymyalgia rheumatica was admitted with severe and constant pain in the right hip, radiating to the right knee. She had a history of steroid-induced osteoporosis, for which she was started on risedronate four years earlier. She had no history of trauma. Her blood results were unremarkable. Her X-rays confirmed that she had an incomplete right subtrochanteric femoral fracture. A bone scan confirmed the diagnosis and also ruled out any other associated fractures. Our patient successfully underwent internal nail fixation of the fracture. She was reviewed by a rheumatology team, which stopped the risedronate. She was started on treatment with denosumab injection. CONCLUSIONS: Previous case series have reported that long-term bisphosphonate use is associated with atypical fractures of the femur, and certain criteria have been established to help identify such rare fractures. Delayed union or non-union is expected in such fractures following definitive orthopedic treatment because of the long half life of bisphosphonates. In this case report, we try to raise questions related to this important subject, like the duration and safety of bisphosphonate use and the alternative medications used in osteoporosis in this rare condition. We consider this case report not only interesting but also important and unusual because it is about a patient who developed a potentially rare and serious side effect of long-term bisphosphonate use, estimated to affect 2.3 in every 10,000 patients, and who presented with a pelvic X-ray that showed the characteristic features of atypical fractures secondary to risedronate use. In addition, most of the documented cases have been associated with many years of bisphosphonate use whereas our patient had been on risedronate for only four years. BioMed Central 2012-09-03 /pmc/articles/PMC3459800/ /pubmed/22943389 http://dx.doi.org/10.1186/1752-1947-6-272 Text en Copyright ©2012 Alfahad et al.; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Case Report
Alfahad, Anas
Thet, Ei Mon
Radwan, Fawzy
Sudhakar, Joe
Nini, Khin
Tachtatzis, Phaedra
Spontaneous Incomplete transverse subtrochanteric femoral fracture with cortical thickening possibly secondary to risedronate use: a case report
title Spontaneous Incomplete transverse subtrochanteric femoral fracture with cortical thickening possibly secondary to risedronate use: a case report
title_full Spontaneous Incomplete transverse subtrochanteric femoral fracture with cortical thickening possibly secondary to risedronate use: a case report
title_fullStr Spontaneous Incomplete transverse subtrochanteric femoral fracture with cortical thickening possibly secondary to risedronate use: a case report
title_full_unstemmed Spontaneous Incomplete transverse subtrochanteric femoral fracture with cortical thickening possibly secondary to risedronate use: a case report
title_short Spontaneous Incomplete transverse subtrochanteric femoral fracture with cortical thickening possibly secondary to risedronate use: a case report
title_sort spontaneous incomplete transverse subtrochanteric femoral fracture with cortical thickening possibly secondary to risedronate use: a case report
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3459800/
https://www.ncbi.nlm.nih.gov/pubmed/22943389
http://dx.doi.org/10.1186/1752-1947-6-272
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