Conservative treatment of recurrent symptoms of an incomplete, atypical femoral fracture associated with glucocorticoid, bisphosphonate, and denosumab therapy in a patient with chronic obstructive pulmonary disease
Journal
Acta Clinica Belgica: International Journal of Clinical and Laboratory Medicine
Journal Volume
74
Journal Issue
5
Pages
370-374
Date Issued
2019
Author(s)
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. ? 2018, ? 2018 Acta Clinica Belgica.
Subjects
atypical femoral fracture; bisphosphonate; Chronic obstructive pulmonary disease; denosumab; glucocorticoid; incomplete
Other Subjects
alendronic acid; analgesic agent; bisphosphonic acid derivative; denosumab; fosamax plus; glucocorticoid; parathyroid hormone[1-34]; prednisolone; raloxifene; strontium ranelate; zoledronic acid; bisphosphonic acid derivative; bone density conservation agent; denosumab; glucocorticoid; aged; Article; asthma; atypical femoral fracture; bone density; bone radiography; bone scintiscanning; brain cortex lesion; case report; chronic obstructive lung disease; clinical article; compression fracture; congestive heart failure; conservative treatment; disease exacerbation; drug substitution; drug withdrawal; dual energy X ray absorptiometry; female; femur fracture; fracture healing; hip radiography; human; insurance; knee replacement; lung edema; musculoskeletal pain; osteoporosis; recurrent disease; stress fracture; thigh pain; thigh pain; chronic obstructive lung disease; complication; conservative treatment; drug effect; femur fracture; osteoporosis; recurrent disease; Aged; Bone Density Conservation Agents; Conservative Treatment; Denosumab; Diphosphonates; Female; Femoral Fractures; Fracture Healing; Glucocorticoids; Humans; Osteoporosis; Pulmonary Disease, Chronic Obstructive; Recurrence
Publisher
Taylor and Francis Ltd.
Type
journal article