Objective: Bisphosphonates are used as first-line therapy for postmenopausal osteoporosis owing to their potent inhibition of bone resorption. Long-term use of bisphosphonates may lead to low-energy femoral subtrochanteric or shaft fractures in a very few patients. The aim of this study was to describe the clinical course of a patient treated with alendronate for 3 years who developed an atypical femoral fracture and to hypothesize the beneficial effects of teriparatide on the healing of the patient’s atypical femoral fracture.
Methods: A 63-year-old Asian woman had a lumbar osteoporotic fracture and received 70 mg of alendronate for 3 years. Pain and soreness in the thigh presented initially and exacerbated thereafter. X-ray revealed a right femoral diaphysis stress fracture. She then received teriparatide for the treatment of osteoporosis and the femoral atypical fracture.
Results: Pain and tenderness improved remarkably after teriparatide treatment for 1 month, and these symptoms disappeared after teriparatide treatment for 9 months. The patient also received raloxifen as further therapy, and the fracture line had completely disappeared by 15 months after treatment.
Conclusions: Even though a previous study has reported that teriparatide healed stress fractures in a rat model and even with the time course of fracture healing in our patient, we are still not certain that teriparatide played a primary role in the positive response to therapy. Vitamin D therapy, calcium, and alendronate discontinuation may have played secondary roles. This case report may serve to introduce a direction for future research into the pharmacological treatment of atypical femoral fractures. Surgical treatment of incomplete atypical femoral fractures may be a safer method.
From the 1Department of Orthopedics, Kaohsiung Medical University Hospital and 2Department of Orthopedics, Faculty of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; 3Department of Obstetrics and Gynecology, College of Medicine, National Cheng Kung University and Hospital, Tainan City, Taiwan; and 4Department of Orthopedics, Kaohsiung Municipal Ta-Tung Hospital, 5Graduate Institute of Medicine, College of Medicine, 6Orthopedic Research Center, and 7Department of Sports Medicine, Faculty of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
Received March 3, 2012; revised and accepted May 17, 2012.
Funding/support: This study was supported, in part, by grants from the National Science Council (NSC97-2314-B-037-003-MY3), the Kaohsiung Medical University Hospital (KMUH97-7R34), and the National Health Research Institutes (NHRI-EX99-9935EI) of Taiwan.
Financial disclosure/conflicts of interest: None reported.
Address correspondence to: Chung-Hwan Chen, MD, Department of Orthopedics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, No. 100 Tzu-You First Road, Kaohsiung City, Taiwan. E-mail: firstname.lastname@example.org