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Antiresorptive-associated spontaneous fractures of both tibiae, followed by an atypical femur fracture during the sequential treatment with alendronate, denosumab then teriparatide.

Published version
Peer-reviewed

Repository DOI


Change log

Authors

Tan, Juan 
Sano, Hiroshige 

Abstract

A 35-year-old man with juvenile idiopathic arthritis since childhood presented with bilateral atypical tibial fractures, followed by a later, single atypical fracture of the femur. The fractures were associated with 6 years of oral alendronate treatment immediately followed by subcutaneous denosumab therapy and later teriparatide therapy for osteoporosis. Atypical fractures are known to occur in the femur following bisphosphonate therapy; however, there are only a few documented cases of atypical fractures in the tibia. Our case highlights a rare but serious complication of a commonly prescribed antiresorptive agent. It also shows that teriparatide, while helpful in increasing bone mass, does not fully prevent the development of atypical fractures. Careful investigation should be considered in patients on long-term antiresorptive therapy presenting with bony tenderness to exclude an atypical fracture.

Description

Keywords

calcium and bone, drugs: musculoskeletal and joint diseases, musculoskeletal and joint disorders, orthopaedic and trauma surgery, osteoporosis, Absorptiometry, Photon, Adult, Alendronate, Bone Density, Denosumab, Dose-Response Relationship, Drug, Drug Administration Schedule, Femoral Fractures, Follow-Up Studies, Fractures, Spontaneous, Humans, Male, Osteoporosis, Risk Assessment, Teriparatide, Tibial Fractures

Journal Title

BMJ Case Rep

Conference Name

Journal ISSN

1757-790X
1757-790X

Volume Title

12

Publisher

BMJ
Sponsorship
Cambridge University Hospitals NHS Foundation Trust (CUH) (146281)
Cambridge NIHR Biomedical Research Centre