You could be reading the full-text of this article now if you...

If you have access to this article through your institution,
you can view this article in

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

doi: 10.1097/gme.0b013e318260143d
Case Reports

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:

©2012The North American Menopause Society