Advertisement

Osteoporosis International

, Volume 27, Issue 2, pp 827–832 | Cite as

Simultaneous bilateral atypical femoral fracture in a patient receiving denosumab: case report and literature review

  • J. Selga
  • J. H. NuñezEmail author
  • J. Minguell
  • M. Lalanza
  • M. Garrido
Case Report

Abstract

Osteoporosis remains a chronic and common disease associated with high medical costs. Pharmacological therapy has shown to be a good strategy to significantly reduce fracture risk. While literary evidence for bone protection in the short and medium term is strongly in it’s favor, there are concerns about long-term treatment with antiresorptive drugs. Increased risk of atypical femoral fractures (AFFs) have been demonstrated in several studies following the long-term use of bisphosphonate. Denosumab offers an alternative approach to the treatment of osteoporosis, however, it is also an antiresorptive drug. We present a case of simultaneous bilateral atypical femoral fractures in a patient with denosumab treatment. These findings highlight the need to reevaluate the optimal antiresorptive therapy duration, as well as the safety of transition from bisphosphonates to denosumab and the need for continued monitoring in the prevention of AFFs.

Keywords

Atypical femoral fractures Bisphosphonates Denosumab Osteoporosis 

Notes

Compliance with ethical standards

Conflicts of interest

None.

References

  1. 1.
    Johnell O, Kanis JA (2006) An estimate of the worldwide prevalence and disability associated with osteoporotic fractures. Osteoporos Int 17(12):1726–33. doi: 10.1007/s00198-006-0172-4 CrossRefPubMedGoogle Scholar
  2. 2.
    Favus MJ (2010) Bisphosphonates for osteoporosis. N Engl J Med 363(21):2027–35. doi: 10.1056/NEJMct1004903 CrossRefPubMedGoogle Scholar
  3. 3.
    Reginster JY (2011) Antifracture efficacy of currently available therapies for postmenopausal osteoporosis. Drugs 71(1):65–78. doi: 10.2165/11587570-000000000-00000 CrossRefPubMedGoogle Scholar
  4. 4.
    Unnanuntana A, Saleh A, Mensah KA, Kleimeyer JP, Lane JM (2013) Atypical femoral fractures: what do we know about them?: AAOS Exhibit Selection. J Bone Joint Surg Am 95(2):e8 1–13. doi: 10.2106/JBJS.L.00568 CrossRefGoogle Scholar
  5. 5.
    Cummings SR, San Martin J, McClung MR, Siris ES, Eastell R, Reid IR, Delmas P, Zoog HB, Austin M, Wang A, Kutilek S, Adami S, Zancetta J, Libanati C, Siddhanti S, Christiansen C (2009) Denosumab for prevention of fractures in postmenopausal women with osteoporosis. N Engl J Med 361(8):756–65. doi: 10.1056/NEJMoa0809493 CrossRefPubMedGoogle Scholar
  6. 6.
    Aspenberg P (2014) Denosumab and atypical femoral fractures. Acta Orthop 85(1):1–2. doi: 10.3109/17453674.2013.859423 PubMedCentralCrossRefPubMedGoogle Scholar
  7. 7.
    Neviaser AS, Lane JM, Lenart BA, Edobor-Osula F, Lorich DG (2008) Low energy femoral shaft fractures associated with alendronate use. J Orthop Trauma 22(5):346–50. doi: 10.1097/BOT.0b013e318172841c CrossRefPubMedGoogle Scholar
  8. 8.
    Silverman S, Christiansen C (2012) Individualizing osteoporosis therapy. Osteoporos Int 23(3):797–809. doi: 10.1007/s00198-011-1775-y CrossRefPubMedGoogle Scholar
  9. 9.
    Min YK (2015) Update on denosumab treatment in postmenopausal women with osteoporosis. Endocrinol Metab 30(1):19–26. doi: 10.3803/EnM.2015.30.1.19 CrossRefGoogle Scholar
  10. 10.
    Balach T, Baldwin PC, Intravia J (2015) Atypical femur fractures associated with diphosphonate use. J Am Acad Orthop Surg 23(9):550–7. doi: 10.5435/JAAOS-D-14-00024 CrossRefPubMedGoogle Scholar
  11. 11.
    Dell RM, Adams AL et al (2012) Incidence of atypical nontraumatic diaphyseal fractures of the femur. J Bone Miner Res 27(12):2544–50. doi: 10.1002/jbmr.1719 CrossRefPubMedGoogle Scholar
  12. 12.
    Seraphim A, Al-Hadithy N, Mordecai SC, Al-Nammari S (2012) Do bisphosphonates cause femoral insufficiency fractures? J Orthop Traumatol 13(4):171–7. doi: 10.1007/s10195-012-0207-x PubMedCentralCrossRefPubMedGoogle Scholar
  13. 13.
    Ettinger B, Burr DB, Ritchie RO (2013) Proposed pathogenesis for atypical femoral fractures: lessons from materials research. Bone 55(2):495–500. doi: 10.1016/j.bone.2013.02.004 CrossRefPubMedGoogle Scholar
  14. 14.
    S. Papapoulos, K. Lippuner, et al. The effect of 8 or 5 years of denosumab treatment in postmenopausal women with osteoporosis: results from the FREEDOM Extension study. Osteoporos Int. 2015 Jul 23. [Epub ahead of print]. doi:  10.1007/s00198-015-3234-7.
  15. 15.
    Paparodis R, Buehring B, Pelley EM, Binkley N (2013) A case of an unusual subtrochanteric fracture in a patient receiving denosumab. Endocr Pract 19(3):e64–8. doi: 10.4158/EP12367.CR CrossRefPubMedGoogle Scholar
  16. 16.
    Thompson RN, Armstrong CL, Heyburn G (2014) Bilateral atypical femoral fractures in a patient prescribed denosumab–a case report. Bone 61:44–7. doi: 10.1016/j.bone.2013.12.027 CrossRefPubMedGoogle Scholar
  17. 17.
    Villiers J, Clark DW, Jeswani T, Webster S, Hepburn AL (2013) An atraumatic femoral fracture in a patient with rheumatoid arthritis and osteoporosis treated with denosumab. Case Rep Rheumatol 2013:249872. doi: 10.1155/2013/249872 PubMedCentralPubMedGoogle Scholar
  18. 18.
    Drampalos E, Skarpas G, Barbounakis N, Michos I (2014) Atypical femoral fractures bilaterally in a patient receiving denosumab. Acta Orthop 85(1):3–5. doi: 10.3109/17453674.2013.854668 PubMedCentralCrossRefPubMedGoogle Scholar
  19. 19.
    Schilcher J, Aspenberg P (2014) Atypical fracture of the femur in a patient using denosumab—a case report. Acta Orthop 85(1):6–7. doi: 10.3109/17453674.2014.885355 PubMedCentralCrossRefPubMedGoogle Scholar
  20. 20.
    Khow KSF, Yong TY (2015) Atypical femoral fracture in a patient treated with denosumab. J Bone Miner Metab 33(3):355–8. doi: 10.1007/s00774-014-0606-6 CrossRefPubMedGoogle Scholar
  21. 21.
    Shane E, Burr D, Abrahamsen B, Adler RA, Brown TD et al (2014) Atypical subtrochanteric and diaphyseal femoral fractures: second report of a task force of the American Society for Bone and Mineral Research. J Bone Miner Res 29(1):1–23. doi: 10.1002/jbmr.1998 CrossRefPubMedGoogle Scholar
  22. 22.
    Khan SA, Kanis JA et al (1997) Elimination and biochemical responses to intravenous alendronate in postmenopausal osteoporosis. J Bone Miner Res 12(10):1700–7. doi: 10.1359/jbmr.1997.12.10.1700 CrossRefPubMedGoogle Scholar
  23. 23.
    Craig M, Capeci MD, Nirmal C, Tejwani MD (2009) Bilateral low-energy simultaneous or sequential femoral fractures in patients on long-term alendronate therapy. J Bone Joint Surg Am 91(11):2556–61. doi: 10.2106/JBJS.H.01774 CrossRefGoogle Scholar
  24. 24.
    Patel VC, Lazzarini AM (2010) Bilateral simultaneous femoral diaphyseal fractures in a patient with long-term ibandronate use. Orthopedics 33(10):775. doi: 10.3928/01477447-20100826-31 PubMedGoogle Scholar
  25. 25.
    Puah KL, Tan MH (2011) Bisphosphonate-associated atypical fracture of the femur: Spontaneous healing with drug holiday and re-appearance after resumed drug therapy with bilateral simultaneous displaced fractures--a case report. Acta Orthop 82(3):380–2. doi: 10.3109/17453674.2011.581267 PubMedCentralCrossRefPubMedGoogle Scholar
  26. 26.
    Ovaska MT, Mäkinen TJ, Madanat R (2011) Simultaneous bilateral subtrochanteric fractures following risedronate therapy. J Orthop Sci 16(4):467–70. doi: 10.1007/s00776-011-0058-y CrossRefPubMedGoogle Scholar
  27. 27.
    Zafeiris CP, Stathopoulos IP, Kourkoumelis G, Gkikas E, Lyritis GP (2012) Simultaneous bilateral atypical femoral fractures after alendronate therapy. J Musculoskelet Neuronal Interact 12(4):262–4PubMedGoogle Scholar
  28. 28.
    Schilcher J, Michaëlsson K, Aspenberg P (2011) Bisphosphonate use and atypical fractures of the femoral shaft. N Engl J Med 364(18):1728–37. doi: 10.1056/NEJMoa1010650 CrossRefPubMedGoogle Scholar
  29. 29.
    Banffy MB, Vrahas MS, Ready JE, Abraham JA (2011) Nonoperative versus prophylactic treatment of bisphosphonate-associated femoral stress fractures. Clin Orthop Relat Res 469(7):2028–34. doi: 10.1007/s11999-011-1828-8 PubMedCentralCrossRefPubMedGoogle Scholar
  30. 30.
    Weil YA, Rivkin G, Safran O, Liebergall M, Foldes AJ (2011) The outcome of surgically treated femur fractures associated with long-term bisphosphonate use. J Trauma 71(1):186–90. doi: 10.1097/TA.0b013e31821957e3 CrossRefPubMedGoogle Scholar
  31. 31.
    Teo BJ, Koh JS, Goh SK, Png MA, Chua DT, Howe TS (2014) Post-operative outcomes of atypical femoral subtrochanteric fracture in patients on bisphosphonate therapy. Bone Joint J 96-B(5):658–64. doi: 10.1302/0301-620X.96B5.32887 CrossRefPubMedGoogle Scholar

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2015

Authors and Affiliations

  • J. Selga
    • 1
  • J. H. Nuñez
    • 1
    Email author
  • J. Minguell
    • 1
  • M. Lalanza
    • 1
  • M. Garrido
    • 1
  1. 1.Department of Orthopaedic Surgery of Vall d’Hebron HospitalPaseo de la Vall d’HebronBarcelonaSpain

Personalised recommendations