A case of atypical femur fracture during long-term treatment with bisphosphonates in patient with postmenopausal osteoporosis
https://doi.org/10.14341/osteo10286
Abstract
Bisphosphonates is a first-line therapy for treatment of osteoporosis. In the last decade, the number of atypical femur fracture (AFF) cases during long-term treatment with bisphosphonates has increased. The aim of this article was to analyze the literature data on this problem, to define the diagnostic criteria of AFF and to present the case of AFF in the patient who received treatment with alendronate for 3.5 years.
A 78-year-old woman, receiving oral bisphosphonate for severe postmenopausal osteoporosis for 3.5 years, suddenly started feeling pain in her right thigh while walking. Three months later, she had got a fracture in middle third of the right femur after falling from her standing height. According to instrumental diagnostics, this fracture had all criteria of AFF. Blocking intramedullary osteosynthesis with shafts was performed. A retrospective analysis of soft tissue magnetic resonance imaging in the area of right thigh, done before the fracture, showed the presence of undiagnosed incomplete right femur fracture in the middle third, which subsequently led to a complete fracture.
Presented clinical case demonstrates the complexity of AFF diagnostics. The purpose of the publication is to draw attention of medical specialists to the issue of this rare side effect of bisphosphonate treatment.
About the Authors
Kira E. Zotkina
Almazov National Medical Research Centre; Clinical Rheumatology Hospital N 25
Russian Federation
Russian Federation
Olga M. Lesnyak
North-western State Medical University named after I.I. Mechnikov; Clinical Rheumatology Hospital N 25
Russian Federation
Russian Federation
MD, PhD, Professor
Aleksandr Yu. Kochish
Vreden Russian Order of Red Banner of Labor Research Institute of Traumatology and Orthopedics
Russian Federation
Russian Federation
MD, PhD, Professor
Ivan V. Sushkov
Vreden Russian Order of Red Banner of Labor Research Institute of Traumatology and Orthopedics
Russian Federation
Russian Federation
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1. Fig. 1. Illustrative sections of an MRI scan of the right thigh of patient K. dated November 9, 2017 | |
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2. Fig. 2. Radiograph of the right lower limb of patient K. on the day of transverse diaphyseal atypical fracture of the right femur, type 42A1 according to the classification of the Osteosynthesis Association, dated 04.12.2017. | |
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3. Fig. 3. Radiograph of the right thigh of patient K. 8 weeks after the intramedullary osteosynthesis of the femur with a pin with a blocker, dated January 26, 2018. | |
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For citations:
Zotkina K.E., Lesnyak O.M., Kochish A.Yu., Sushkov I.V. A case of atypical femur fracture during long-term treatment with bisphosphonates in patient with postmenopausal osteoporosis. Osteoporosis and Bone Diseases. 2019;22(1):18-23. (In Russ.) https://doi.org/10.14341/osteo10286
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