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Successful teriparatide treatment of atypical fracture after long-term use of alendronate without surgical procedure in a postmenopausal woman: a case report

Huang, Hsuan-Ti MD1,2; Kang, Lin MD3; Huang, Peng-Ju MD1,2,4; Fu, Yin-Chih MD1,2,5,6; Lin, Sung-Yen MD1,2,4,5,6; Hsieh, Chih-Hsin MD1,2; Chen, Jian-Chih MD1,2; Cheng, Yuh-Min MD1,2; Chen, Chung-Hwan MD1,2,5,6,7

Menopause:
doi: 10.1097/gme.0b013e318260143d
Case Reports
Abstract

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.

Author Information

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: hwan@kmu.edu.tw

©2012The North American Menopause Society