DOI QR코드

DOI QR Code

류마티스관절염 환자에서 발생한 비정형 대퇴골 골절의 1예

Atypical Femoral Fracture in a Patient with Rheumatoid Arthritis

  • 김담 (한양대학교 류마티스병원 류마티스내과) ;
  • 정소담 (한양대학교 의과대학 내과학교실) ;
  • 손창남 (한양대학교 류마티스병원 류마티스내과) ;
  • 최지영 (한양대학교 류마티스병원 류마티스내과) ;
  • 이승훈 (한양대학교 의과대학 영상의학과교실) ;
  • 김이석 (한양대학교 의과대학 정형외과학교실) ;
  • 성윤경 (한양대학교 류마티스병원 류마티스내과)
  • Kim, Dam (Department of Rheumatology, Hospital for Rheumatic Diseases, Hanyang University College of Medicine) ;
  • Jung, Sodam (Department of Internal Medicine, Hanyang University College of Medicine) ;
  • Son, Chang-Nam (Department of Rheumatology, Hospital for Rheumatic Diseases, Hanyang University College of Medicine) ;
  • Choi, Ji-Young (Department of Rheumatology, Hospital for Rheumatic Diseases, Hanyang University College of Medicine) ;
  • Lee, Seunghun (Department of Radiology, Hanyang University College of Medicine) ;
  • Kim, Yee-Suk (Department of Orthoperdic Surgery, Hanyang University College of Medicine) ;
  • Sung, Yoon-Kyoung (Department of Rheumatology, Hospital for Rheumatic Diseases, Hanyang University College of Medicine)
  • 투고 : 2013.08.26
  • 심사 : 2013.11.11
  • 발행 : 2014.08.01

초록

류마티스관절염 환자에서 질환 자체의 활성도나 질환으로 인한 비스포스포네이트의 장기간 사용 및 PPI, 스테로이드의 사용으로 비정형 대퇴골 골절의 위험도가 높아질 수 있으므로 비정형 대퇴골 골절에 대한 많은 연구가 필요하다고 생각하며 대퇴부 통증이 있는 경우 비정형 대퇴골 골절을 염두에 두고 면밀한 진찰과 영상진단을 해야 한다.

Atypical femoral fractures are characterized by a subtrochanteric or diaphyseal location. Recent studies have suggested that long-term treatment with bisphosphonates might be associated with the occurrence of atypical femoral fractures. The present report describes a case involving a 60-year-old woman with left buttock pain that was unassociated with trauma. Her hip pain was initially considered to be a symptom of her underlying rheumatoid arthritis, but a plain radiography, bone scintigraphy, and magnetic resonance imaging revealed an insufficiency fracture in the lateral shaft of the left proximal femur. She had been treated with a bisphosphonate for 4.5 years because of a previous vertebral fracture. Her chronic, long-term rheumatoid arthritis and history of bisphosphonate administration were considered to be associated with the development of her atypical femoral fracture.

키워드

참고문헌

  1. Brauer CA, Coca-Perraillon M, Cutler DM, Rosen AB. Incidence and mortality of hip fractures in the United States. JAMA 2009;302:1573-1579. https://doi.org/10.1001/jama.2009.1462
  2. Edwards BJ, Bunta AD, Lane J, et al. Bisphosphonates and nonhealing femoral fractures: analysis of the FDA Adverse Event Reporting System (FAERS) and international safety efforts: a systematic review from the Research on Adverse Drug Events And Reports (RADAR) project. J Bone Joint Surg Am 2013;95:297-307. https://doi.org/10.2106/JBJS.K.01181
  3. Lee YK, Ha YC, Park C, Yoo JJ, Shin CS, Koo KH. Bisphosphonate use and increased incidence of subtrochanteric fracture in South Korea: results from the National Claim Registry. Osteoporos Int 2013;24:707-711. https://doi.org/10.1007/s00198-012-2016-8
  4. Schilcher J, Michaelsson K, Aspenberg P. Bisphosphonate use and atypical fractures of the femoral shaft. N Engl J Med 2011;364:1728-1737. https://doi.org/10.1056/NEJMoa1010650
  5. Gedmintas L, Solomon DH, Kim SC. Bisphosphonates and risk of subtrochanteric, femoral shaft, and atypical femur fracture: a systematic review and meta-analysis. J Bone Miner Res 2013;28:1729-1737. https://doi.org/10.1002/jbmr.1893
  6. Kwek EB, Goh SK, Koh JS, Png MA, Howe TS. An emerging pattern of subtrochanteric stress fractures: a longterm complication of alendronate therapy? Injury 2008;39:224-231. https://doi.org/10.1016/j.injury.2007.08.036
  7. Sung YB, Choi JY, Um KS. Bisphosphonate related atypical femoral fracture. Hip Pelvis 2013;25:66-71. https://doi.org/10.5371/hp.2013.25.1.66
  8. Das De S, Setiobudi T, Shen L, Das De S. A rational approach to management of alendronate-related subtrochanteric fractures. J Bone Joint Surg Br 2010;92:679-686.
  9. Girgis CM, Sher D, Seibel MJ. Atypical femoral fractures and bisphosphonate use. N Engl J Med 2010;362:1848-1849. https://doi.org/10.1056/NEJMc0910389
  10. Neviaser AS, Lane JM, Lenart BA, Edobor-Osula F, Lorich DG. Low-energy femoral shaft fractures associated with alendronate use. J Orthop Trauma 2008;22:346-350. https://doi.org/10.1097/BOT.0b013e318172841c