Hip & pelvis

The Korean Hip Society (대한고관절학회)
권호 표지
DOI QR코드

DOI QR Code

An Uncommon Case of Bilateral Pathologic Hip Fractures: Antiviral Drug-induced Osteomalacia in a Patient with Hepatitis B

  • Moon, Nam Hoon (Department of Orthopaedic Surgery, Pusan National University Hospital, Pusan National University School of Medicine) ;
  • Shin, Won Chul (Department of Orthopaedic Surgery, Medical Research Institute, Pusan National University Yangsan Hospital, Pusan National University School of Medicine) ;
  • Do, Min Uk (Department of Orthopaedic Surgery, Medical Research Institute, Pusan National University Yangsan Hospital, Pusan National University School of Medicine) ;
  • Cho, Hyung Joon (Department of Orthopaedic Surgery, Medical Research Institute, Pusan National University Yangsan Hospital, Pusan National University School of Medicine) ;
  • Suh, Kuen Tak (Department of Orthopaedic Surgery, Medical Research Institute, Pusan National University Yangsan Hospital, Pusan National University School of Medicine)
  • Received : 2018.02.13
  • Accepted : 2018.03.08
  • Published : 2018.06.30
⟨ Previous Next ⟩

Abstract

The long-term use of adefovir and tenofovir-antiviral medications commonly used to treat chronic hepatitis B-can be associated with proximal renal tubular dysfunction resulting in significant hypophosphatemic osteomalacia. However, there have been few reports about pathological fractures requiring surgical stabilization in cases of antiviral drug-induced hypophosphatemic osteomalacia. We present the case of a 51-year-old man who sustained bilateral pathological hip fractures associated with antiviral drug-induced hypophosphatemic osteomalacia. To treat a lamivudine-resistant hepatitis-B viral infection, the patient received adefovir for 7 years followed by tenofovir for the subsequent 3 years. He had suffered from polyarthralgia and generalized weakness for 2 years prior to presentation at our clinic. Misdiagnosis and inadequate management of his condition accelerated weakness of the bone matrix and ultimately induced pathological fractures. The patient was managed via cementless total hip arthroplasty on the left hip and internal fixation on the right hip. This case highlights that orthopaedic surgeons should consider the possibility of hypophosphatemic osteomalacia if patients receiving antiviral drugs complain of polyarthralgia and generalized weakness.

Keywords

References

  1. Koenig KF, Kalbermatter S, Menter T, Graber P, Kiss D. Recurrent bone fractures due to tenofovir-induced renal phosphate wasting. Scand J Infect Dis. 2014;46:221-4. https://doi.org/10.3109/00365548.2013.840921
  2. Tanaka M, Setoguchi T, Ishidou Y, et al. Pathological femoral fractures due to osteomalacia associated with adefovir dipivoxil treatment for hepatitis B: a case report. Diagn Pathol. 2012;7:108. https://doi.org/10.1186/1746-1596-7-108
  3. Jung YK, Yeon JE, Choi JH, et al. Fanconi's syndrome associated with prolonged adefovir dipivoxil therapy in a hepatitis B virus patient. Gut Liver. 2010;4:389-93. https://doi.org/10.5009/gnl.2010.4.3.389
  4. Kim du H, Sung DH, Min YK. Hypophosphatemic osteomalacia induced by low-dose adefovir therapy: focus on manifestations in the skeletal system and literature review. J Bone Miner Metab. 2013;31:240-6. https://doi.org/10.1007/s00774-012-0384-y
  5. Terasaka T, Ueta E, Ebara H, et al. Long-term observation of osteomalacia caused by adefovir-induced Fanconi's syndrome. Acta Med Okayama. 2014;68:53-6.
  6. Jeong HJ, Lee JM, Lee TH, et al. Two cases of hypophosphatemic osteomalacia after long-term low dose adefovir therapy in chronic hepatitis B and literature review. J Bone Metab. 2014;21:76-83. https://doi.org/10.11005/jbm.2014.21.1.76
  7. Sit YK, Lui TH. Corrective osteotomy in femoral non-union in drug-induced hypophosphataemic osteomalacia. BMJ Case Rep. 2014;2014:bcr2013201269. https://doi.org/10.1136/bcr-2013-201269
  8. Tanji N, Tanji K, Kambham N, Markowitz GS, Bell A, D'agati VD. Adefovir nephrotoxicity: possible role of mitochondrial DNA depletion. Hum Pathol. 2001;32:734-40. https://doi.org/10.1053/hupa.2001.25586
  9. Reginato AJ, Coquia JA. Musculoskeletal manifestations of osteomalacia and rickets. Best Pract Res Clin Rheumatol. 2003;17:1063-80. https://doi.org/10.1016/j.berh.2003.09.004
  10. Garden RS. Stability and union in subcapital fractures of the femur. J Bone Joint Surg Br. 1964;46:630-47.
  11. Le May M, Blunt JW Jr. A factor determining the location of pseudofractures in osteomalacia. J Clin Invest. 1949;28:521-5. https://doi.org/10.1172/JCI102099
  12. Steinbach HL, Kolb FO, Gilfillan R. A mechanism of the production of pseudofractures in osteomalacia (Milkman's syndrome). Radiology. 1954;62:388-95. https://doi.org/10.1148/62.3.388
  13. Lee C, Lashari S. Pseudofracture of the neck of femur secondary to osteomalacia. J Bone Joint Surg Br. 2007;89:956-8.
  14. Palermo A, Strollo R, Papalia R, et al. Severe hypophosphatemic osteomalacia secondary to Fanconi syndrome due to adefovir: a case report. Endocr Pract. 2014;20:e246-9.