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Spontaneous Non-Traumatic Stress Fractures in Bilateral Femoral Shafts in a Patient Treated with Bisphosphonates

  • Shin, Dong-Yeob (Department of Internal Medicine and Endocrine Research Institute, Yonsei University College of Medicine) ;
  • Ku, Cheol-Ryong (Department of Internal Medicine and Endocrine Research Institute, Yonsei University College of Medicine) ;
  • Kim, Kyung-Min (Department of Internal Medicine and Endocrine Research Institute, Yonsei University College of Medicine) ;
  • Choi, Han-Seok (Department of Internal Medicine and Endocrine Research Institute, Yonsei University College of Medicine) ;
  • Rhee, Yu-Mie (Department of Internal Medicine and Endocrine Research Institute, Yonsei University College of Medicine) ;
  • Lee, Eun-Jig (Department of Internal Medicine and Endocrine Research Institute, Yonsei University College of Medicine) ;
  • Lim, Sung-Kil (Department of Internal Medicine and Endocrine Research Institute, Yonsei University College of Medicine)
  • Published : 2012.03.01

Abstract

Bisphosphonates are potent inhibitors of bone resorption and widely used to treat osteoporosis. Extensive studies have shown that therapy with bisphosphonates improves bone density and decreases fracture risk. However, concerns have been raised about potential over-suppression of bone turnover during long-term use of bisphosphonates, resulting in increased susceptibility to and delayed healing of non-spinal fractures. We report a patient who sustained non-traumatic stress fractures in bilateral femoral shafts with delayed healing after long-term bisphosphonate therapy. She underwent open reduction and surgical internal fixation. Although bisphosphonates effectively prevent vertebral fractures, and their safety has been tested in randomized trials, we must emphasize the need for awareness of the possibility that long-term suppression of bone turnover with bisphosphonates may eventually lead to an accumulation of fatigue-induced damage and adverse skeletal effects such as delayed fracture healing.

Keywords

References

  1. Woo SB, Hellstein JW, Kalmar JR. Narrative [corrected] review: bisphosphonates and osteonecrosis of the jaws. Ann Intern Med 2006;144:753-761. https://doi.org/10.7326/0003-4819-144-10-200605160-00009
  2. Odvina CV, Zerwekh JE, Rao DS, Maalouf N, Gottschalk FA, Pak CY. Severely suppressed bone turnover: a potential complication of alendronate therapy. J Clin Endocrinol Metab 2005;90:1294-1301. https://doi.org/10.1210/jc.2004-0952
  3. Schneider JP. Should bisphosphonates be continued indefinitely? An unusual fracture in a healthy woman on long-term alendronate. Geriatrics 2006;61:31-33.
  4. Armamento-Villareal R, Napoli N, Panwar V, Novack D. Suppressed bone turnover during alendronate therapy for highturnover osteoporosis. N Engl J Med 2006;355:2048-2050.
  5. Mashiba T, Mori S, Burr DB, et al. The effects of suppressed bone remodeling by bisphosphonates on microdamage ccumulation and degree of mineralization in the cortical bone of dog rib. J Bone Miner Metab 2005;23 Suppl:36-42.
  6. Boivin G, Meunier PJ. Changes in bone remodeling rate influence the degree of mineralization of bone. Connect Tissue Res 2002;43:535-537. https://doi.org/10.1080/03008200290000934
  7. Bagger YZ, Tanko LB, Alexandersen P, Ravn P, Christiansen C. Alendronate has a residual effect on bone mass in postmenopausal Danish women up to 7 years after treatment withdrawal. Bone 2003;33:301-307. https://doi.org/10.1016/S8756-3282(03)00112-1
  8. Chavassieux PM, Arlot ME, Reda C, Wei L, Yates AJ, Meunier PJ. Histomorphometric assessment of the long-term effects of alendronate on bone quality and remodeling in patients with osteoporosis. J Clin Invest 1997;100:1475-1480. https://doi.org/10.1172/JCI119668
  9. Ravn P, Bidstrup M, Wasnich RD, et al. Alendronate and estrogen-progestin in the long-term prevention of bone loss: four-year results from the early postmenopausal intervention cohort study: a randomized, controlled trial. Ann Intern Med 1999;131:935-942.
  10. Black DM, Schwartz AV, Ensrud KE, et al. Effects of continuing or stopping alendronate after 5 years of treatment: the Fracture Intervention Trial Long-term Extension (FLEX): a randomized trial. JAMA 2006;296:2927-2938. https://doi.org/10.1001/jama.296.24.2927

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  1. Long-term effects of alendronate on fracture healing and bone remodeling of femoral shaft in ovariectomized rats vol.34, pp.3, 2012, https://doi.org/10.1038/aps.2012.170
  2. Atypical femoral fractures related to bisphosphonate treatment : issues and controversies related to their surgical management vol.b99, pp.3, 2012, https://doi.org/10.1302/0301-620x.99b3.bjj-2016-0276.r2