Skip to main content

Advertisement

SpringerLink
Log in

Atypical metatarsal fracture in a patient on long term bisphosphonate therapy

  • Case Report
  • Published:
Indian Journal of Orthopaedics Aims and scope Submit manuscript

Abstract

A 24 years old female of cushing disease had undergone adrenelectomy. She was put on alendronate and steroid. After six and a half years she developed pathological fracture subtrochanteric femur. The patient was treated with proximal femoral nailing and the fracture united. 2 years later she developed pain right foot. She was diagnosed as transverse fracture of fifth metatarsal. We report this rare case of atypical metatarsal fracture in a patient on long term bisphosphonate therapy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Russell RG, Croucher PI, Rogers MJ. Bisphosphonates: Pharmacology, mechanisms of action and clinical uses. Osteoporosis Int. 1999;9(suppl 2):S66–80.

    Article  Google Scholar 

  2. Fleisch H. Bisphosphonates: mechanisms of action. Endocr Rev 1998;19:80–100.

    Article  CAS  Google Scholar 

  3. Roux C, Dougados M. Bisphosphonate in the prevention and treatment of glucocorticoid-induced osteoporosis. Clin Exp Rheumatol 2000;18 (suppl. 21):S49–52.

    Google Scholar 

  4. Harris ST, Watts NB, Genant HK, McKeever CD, Hangartner T, Keller M, et al. Effects of Risedronate treatment on vertebral and nonvertebral fractures in women with postmenopausal osteoporosis: a randomized controlled trial. JAMA 1999;282:1344–52.

    Article  CAS  Google Scholar 

  5. American college of rheumatology Adhoc committee on glucocorticoid - induced osteoporosis: Recommendation for the prevention and treatment of glucocorticoid - induced osteoporosis. 2001 Update. Available from: http://www.rheumatology.org [Last cited on 2011 Sep 07].

    Google Scholar 

  6. Imai K, Yamamoto S, Anamizu Y, Horiuchi T. Pelvic insufficiency fracture associated with severe suppression of bone turnover by alendronate therapy. J Bone Miner Metab. 2007; 25: 333–6.

    Article  Google Scholar 

  7. 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;39:224–31.

    Article  Google Scholar 

  8. Black DM, Cummings SR, Karpf DB, Cauley JA, Thompson DE, Nevitt MC, et al. Randomised trial of effect of alendronate on risk of fracture in women with existing fracture. Fracture intervention trial Research Group. Lancet 1996;348:1535–41.

    Article  CAS  Google Scholar 

  9. Chan SS, Rosenberg ZS, Chan K, Capeci C. Subtrochanteric femoral fractures in patients receiving longterm alendronate therapy: Imaging features. AJR Am J Roentgenol 2010;194:1581–6.

    Article  Google Scholar 

  10. Krestan C, Hojreh A. Imaging of insufficiency features. Eur J Radiol 2009;71:398–405.

    Article  Google Scholar 

  11. Spitz DJ, Newberg AH. Imaging of stress fractures in the athelete. Radiol Clin North Am 2002;40:313–31.

    Article  Google Scholar 

  12. Seeman E, Delmas PD. Reconstructing the skeleton with intermittent parathyroid hormone. Trends Endocrinol Metab 2001;12:281–3

    Article  CAS  Google Scholar 

  13. Drake MT, Clarke BL, Khosala S. Bisphosphonate: Mechanism of action and role in clinical practice. Mayo Clin Proc 2008;83:1032–45.

    Article  CAS  Google Scholar 

  14. Yeap SS, Hosking DJ. Management of corticosteroid - induced osteoporosis. Rheumatology 2002;41:1088–94.

    Article  CAS  Google Scholar 

  15. US Food and Drug administration. FDA Drug safety communication: Safety update for osteoporosis drugs, bisphosphonates, and atypical fractures. Available from: http://www.fda.gov/Drugs/DrugSafety/ucm229009. [Last cited on 2010 Oct 13].

  16. Cummings SR, Black DM, Thompson DE, Applegate WB, Barrett- Connor E, Musliner TA, et al. Effect of alendronate on risk of fracture in women with low bone density but with out vertebral fractures. JAMA December 23/30, 1998;280:2077–82.

    Article  CAS  Google Scholar 

  17. Black DM, Schwartz AV, Ensrud KE, Cauley JA, Levis S, Quandt SA, et al. Effects of continuing of stopping alendronate after 5 years of treatment: the fracture intervention trial long term extension (FLEX): a randomized trial. JAMA 2006;296:2927–38.

    Article  CAS  Google Scholar 

  18. Alkhiary YM, Gerstenfeld LC, Krall E, Westmore M, Sato M, Mitlak BH, et al. Enhancement of experimental fracture-healing by systemic administration of recombinant human parathyroid hormone (PTH 1–34). J Bone Joint Surg Am 2005;87:731–41.

    PubMed  Google Scholar 

  19. Saag KG, Shane E, Boonen S, Marín F, Donley DW, Taylor KA, et al. Teriparatide or alendronate in glucocorticoid-induced osteoporosis. N Engl J Med 2007;357:2028–39.

    Article  CAS  Google Scholar 

  20. Jia D, O’Brien CA, Stewart SA, Manolagas SC, Weinstein RS. Glucocorticoids act directly on osteoclasts to increase their life span and reduce bone density. Endocrinology 2006;147:5592–9.

    Article  CAS  Google Scholar 

  21. Forteo (teriparatide, Eli Lilly and Company, Indianapolis, IN). Full prescribing information, 2002.

  22. 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;90:1294–301.

    Article  CAS  Google Scholar 

  23. Goh SK, Yang KY, Koh JS, Wong MK, Chua SY, Chua DT, et al. Subtrochanteric insufficiency fractures in patients on alendronate therapy: A caution. J Bone Joint Surg Br 2007;89:349–53.

    Article  Google Scholar 

  24. Agarwal S, Agarwal S, Gupta P, Agarwal PK, Agarwal G, Bansal A. Risk of atypical fracture with long term use of alendronate (Bisphosphonate): A systemic review of literature. Acta Orthop Belg 2010;76:567–71.

    PubMed  Google Scholar 

  25. Cheung RK, Leung KK, Lee KC, Chow TC. Sequential non traumatic femoral shaft fractures in a patient on long term alendronate. Hong Kong Med J 2007;13:485–9.

    PubMed  Google Scholar 

  26. Li J, Mashiba T, Burr DB. Bisphosphonate treatment suppresses not only stochastic remodeling but also the targeted repair of microdamage. Calcif Tissue Int 2001;69:281–6.

    Article  CAS  Google Scholar 

  27. Mashiba T, Turner CH, Hirano T, Forwood MR, Johnston CC, Burr DB. Effects of suppressed bone turnover by bisphosphonates on microdamage accumulation and biomechanical properties in clinically relevant skeletal sites in beagles. Bone 2001;28:524–31.

    Article  CAS  Google Scholar 

  28. Hirano T, Turner CH, Forwood MR, Johnston CC, Burr DB. Does suppression of bone turnover impair mechanical properties by allowing microdamage accumulation? Bone 2000;21:13–20.

    Article  Google Scholar 

  29. Boivin G, Meunier PJ. Changes in bone remodeling rate influence the degree of mineralization of bone. Connect Tissue Res 2002;43:535–7.

    Article  CAS  Google Scholar 

  30. Akkus O, Polyakova-Akkus A, Adar F, Schaffler MB. Aging and microstructural compartments in human compact bone. J Bone Miner Res 2003;18:1012–9.

    Article  CAS  Google Scholar 

  31. Ciarella TE, Fyhrie DP, Parfitt AM. Effects of vertebral bone fragility and bone formation rate on the mineralization levels of cancellous bone from white females. Bone 2003;32:311–5.

    Article  Google Scholar 

  32. Currey JD. Effects of differences in mineralization on the mechanical properties of bone. Philos Trans R Soc Lond B Biol Sci 1984;304:509–18.

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Orthopaedics, BRD Medical College, Gorakhpur, Uttar Pradesh, India

    Pavan Pradhan,  Vikas Saxena (Assistant Professor), Ashok Yadav & Vineet Mehrotra

Authors
  1. Pavan Pradhan
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Vikas Saxena
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ashok Yadav
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Vineet Mehrotra
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Vikas Saxena.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Pradhan, P., Saxena, V., Yadav, A. et al. Atypical metatarsal fracture in a patient on long term bisphosphonate therapy. IJOO 46, 589–592 (2012). https://doi.org/10.4103/0019-5413.101048

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.4103/0019-5413.101048

Key words

Search

Navigation