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Bilateral Atypical Femur Fractures After Denosumab in a Bisphosphonate Naive Patient: A Case Report

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Abstract

A case report of bilateral atypical femur fractures (AFF) in a bisphosphonate naive patient. A 62-year-old female bisphosphonate naive patient was started on denosumab for osteoporosis. Approximately 3 years later she complained of right hip pain and was found to have a bilateral incomplete AFFs. She was asymptomatic on the left lower limb. Patient was managed conservatively and placed on protected weight bearing on both legs. Symptoms subsequently resolved over a period of 3 months, although radiographic findings remained at approximately 1 year. AFFs may be associated with patients on denosumab therapy even without a prior history of bisphosphonate use. Patients should be counselled appropriately and monitored for such complications.

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References

  1. Black DM, Geiger EJ, Eastell R et al (2020) Atypical femur fracture risk versus fragility fracture prevention with bisphosphonates. N Engl J Med 383(8):743–753. https://doi.org/10.1056/NEJMoa1916525

    Article  CAS  PubMed  Google Scholar 

  2. Takahashi M, Ozaki Y, Kizawa R et al (2019) Atypical femoral fracture in patients with bone metastasis receiving denosumab therapy: a retrospective study and systematic review. BMC Cancer 19(1):980. https://doi.org/10.1186/s12885-019-6236-6

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Shane E, Burr D, Abrahamsen B, Adler RA, Brown TD, Cheung AM, Cosman F, Curtis JR, Dell R, Dempster DW, Ebeling PR, Einhorn TA, Genant HK, Geusens P, Klaushofer K, Lane JM, McKiernan F, McKinney R, Ng A, Nieves J, O’Keefe R, Papapoulos S, Howe TS, van der Meulen MC, Weinstein RS, Whyte MP (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 29:1–23. https://doi.org/10.1002/jbmr.1998

    Article  PubMed  Google Scholar 

  4. Patel AA, Ramanathan R, Kuban J, Willis MH (2015) Imaging findings and evaluation of metabolic bone disease. Adv Radiol 2015:1–21. https://doi.org/10.1155/2015/812794

    Article  Google Scholar 

  5. Bone HG, Chapurlat R, Brandi ML, Brown JP, Czerwinski E, Krieg MA, Mellström D, Radominski SC, Reginster JY, Resch H, Ivorra JA, Roux C, Vittinghoff E, Daizadeh NS, Wang A, Bradley MN, Franchimont N, Geller ML, Wagman RB, Cummings SR, Papapoulos S (2013) The effect of three or six years of denosumab exposure in women with postmenopausal osteoporosis: results from the FREEDOM extension. J Clin Endocrinol Metab 98(11):4483–4492. https://doi.org/10.1210/jc.2013-1597

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. 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 2013:1–4. https://doi.org/10.1155/2013/249872

    Article  Google Scholar 

  7. Thompson RN, Armstrong CL, Heyburn G (2014) Bilateral atypical femoral fractures in a patient prescribed denosumab—a case report. Bone 61:44–47. https://doi.org/10.1016/j.bone.2013.12.027

    Article  PubMed  Google Scholar 

  8. Khow KS, Yong TY (2014) Atypical femoral fracture in a patient treated with denosumab. J Bone Miner Metab 33(3):355–358. https://doi.org/10.1007/s00774-014-0606-6

    Article  CAS  PubMed  Google Scholar 

  9. Schilcher J, Aspenberg P (2014) Atypical fracture of the femur in a patient using denosumab—a case report. Acta Orthop 85(1):6–7. https://doi.org/10.3109/17453674.2014.885355

    Article  PubMed  PubMed Central  Google Scholar 

  10. Drampalos E, Skarpas G, Barbounakis N, Michos I (2013) Atypical femoral fractures bilaterally in a patient receiving denosumab. Acta Orthop 85(1):3–5. https://doi.org/10.3109/17453674.2013.854668

    Article  PubMed  Google Scholar 

  11. Ramchand SK, Chiang CY, Zebaze RM, Seeman E (2015) Recurrence of bilateral atypical femoral fractures associated with the sequential use of teriparatide and denosumab: a case report. Osteoporos Int 27(2):821–825. https://doi.org/10.1007/s00198-015-3354-0

    Article  PubMed  Google Scholar 

  12. Selga J, Nuñez J, Minguell J, Lalanza M, Garrido M (2015) Simultaneous bilateral atypical femoral fracture in a patient receiving denosumab: case report and literature review. Osteoporos Int 27(2):827–832. https://doi.org/10.1007/s00198-015-3355-z

    Article  Google Scholar 

  13. Lai KH, Chiang CY, Yang RS, Yang KC, Wu CC (2019) Conservative treatment of recurrent symptoms of an incomplete, atypical femoral fracture associated with glucocorticoid, bisphosphonate, and denosumab therapy in a patient with chronic obstructive pulmonary disease. Acta Clin Belg. https://doi.org/10.1080/17843286.2018.1534576

    Article  PubMed  Google Scholar 

  14. Tan J, Sano H, Poole K (2019) Antiresorptive-associated spontaneous fractures of both tibiae, followed by an atypical femur fracture during the sequential treatment with alendronate, denosumab then teriparatide. BMJ Case Rep. https://doi.org/10.1136/bcr-2019-229366

    Article  PubMed  PubMed Central  Google Scholar 

  15. Piponov H, Goldstein J, Eisenberg G (2020) Multiple ipsilateral femoral stress fractures in a patient taking denosumab for osteoporosis—a case report. Osteoporos Int 31(11):2263–2267. https://doi.org/10.1007/s00198-020-05499-6

    Article  CAS  PubMed  Google Scholar 

  16. Cosman F, Crittenden D, Adachi J, Binkley N, Czerwinski E, Ferrari S et al (2016) Romosozumab treatment in postmenopausal women with osteoporosis. N Engl J Med 375(16):1532–1543. https://doi.org/10.1056/nejmoa1607948

    Article  CAS  PubMed  Google Scholar 

  17. Paparodis R, Buehring B, Pelley E, Binkley N (2013) A case of an unusual subtrochanteric fracture in a patient receiving denosumab. Endocr Pract 19(3):e64–e68. https://doi.org/10.4158/ep12367.cr

    Article  PubMed  Google Scholar 

  18. Delmas PD, Munoz F, Black DM, Cosman F, Boonen S, Watts NB, Kendler D, Eriksen EF, Mesenbrink PG, Eastell R (2009) Effects of yearly zoledronic acid 5 mg on bone turnover markers and relation of PINP with fracture reduction in postmenopausal women with osteoporosis. J Bone Miner Res 24:1544–1551. https://doi.org/10.1359/jbmr.090310

    Article  CAS  PubMed  Google Scholar 

  19. Iizuka Y, Iizuka H, Kaneko T, Mieda T, Takechi R, Suzuki H, Sorimachi Y, Suto T, Tachibana M, Yoneyama T, Omodaka T, Hashimoto S, Hamano N, Sakane H, Shimoyama D, Kohama I, Ohshima A, Nozaki T, Kamiyama M, Takagishi K (2016) Bone turnover markers and the factors associated with atypical femur fractures among Japanese patients. Injury 47(11):2484–2489. https://doi.org/10.1016/j.injury.2016.09.031

    Article  PubMed  Google Scholar 

  20. Eastell R, Christiansen C, Grauer A, Kutilek S, Libanati C, McClung MR, Reid IR, Resch H, Siris E, Uebelhart D, Wang A, Weryha G, Cummings SR (2011) Effects of denosumab on bone turnover markers in postmenopausal osteoporosis. J Bone Miner Res 26(3):530–537. https://doi.org/10.1002/jbmr.251

    Article  CAS  PubMed  Google Scholar 

  21. Eastell R, Rosen CJ, Black DM, Cheung AM, Murad MH, Shoback D (2019) Pharmacological management of osteoporosis in postmenopausal women: an endocrine society* clinical practice guideline. J Clin Endocrinol Metab 104(5):1595–1622. https://doi.org/10.1210/jc.2019-00221

    Article  PubMed  Google Scholar 

  22. Leder BZ, Tsai JN, Uihlein AV, Wallace PM, Lee H, Neer RM, Burnett-Bowie SA (2015) Denosumab and teriparatide transitions in postmenopausal osteoporosis (the DATA-Switch study): extension of a randomised controlled trial. Lancet 386(9999):1147–1155. https://doi.org/10.1016/S0140-6736(15)61120-5

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. van de Laarschot DM, McKenna MJ, Abrahamsen B, Langdahl B, Cohen-Solal M, Guañabens N, Eastell R, Ralston SH, Zillikens MC (2020) Medical management of patients after atypical femur fractures: a systematic review and recommendations from the European Calcified Tissue Society. J Clin Endocrinol Metab 105(5):1682–1699. https://doi.org/10.1210/clinem/dgz295

    Article  Google Scholar 

  24. Toro G, Ojeda-Thies C, Calabrò G, Toro G, Moretti A, Guerra GM, Caba-Doussoux P, Iolascon G (2016) Management of atypical femoral fracture: a scoping review and comprehensive algorithm. BMC Musculoskelet Disord 17:227. https://doi.org/10.1186/s12891-016-1086-8

    Article  PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Singapore General Hospital, Outram Road Academia Building Level 4, Singapore, 119228, Singapore

    Jeremy Keng Meng Goh, Joyce Suang Bee Koh & Tet Sen Howe

  2. Mount Elizabeth Medical Centre, The Endocrine Clinic, 3 Mount Elizabeth #15-04, Singapore, 228510, Singapore

    Alvin Choong Meng Ng

  3. Department of Diagnostic Radiology, Singapore General Hospital, Block 2, Level 1, Outram Road, Singapore, 169608, Singapore

    Meng Ai Png

Authors
  1. Jeremy Keng Meng Goh
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  2. Joyce Suang Bee Koh
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  4. Meng Ai Png
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  5. Tet Sen Howe
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Correspondence to Jeremy Keng Meng Goh.

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Conflict of interest

Dr Joyce Suang Bee Koh—Moderator and facilitator honorarium from Amgen 2021 and received faculty honorarium from AOTrauma Asia–Pacific 2021. Dr Alvin Choong Meng Ng—Previously received speakers honoraria from Amgen. All other authors declares no conflict of interest.

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IRB: Local institutional review board (IRB) approval was waived for this study, as none required for case reports.

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Goh, J.K.M., Koh, J.S.B., Ng, A.C.M. et al. Bilateral Atypical Femur Fractures After Denosumab in a Bisphosphonate Naive Patient: A Case Report. Calcif Tissue Int 111, 96–101 (2022). https://doi.org/10.1007/s00223-022-00952-6

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  • DOI: https://doi.org/10.1007/s00223-022-00952-6

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