Abstract
Objective: Bisphosphonates were accepted first line treatment for osteoporosis. Long-term bisphosphonate treatment has been reported to be complicated with osteonecrosis of jaw (ONJ) and atypical fracture of femur. It is proposed to be the result of impaired remodeling of minor injury of bone. An atypical fracture occurs on a patient received only 1.5 years of bisphosphonate treatment with continuous decreasing bone mineral density. Case Presentation: This is a 53-year-old female Taiwanese. She has rheumatoid arthritis and has received long-term glucocorticoid treatment. Continuous decrease of bone mineral density in the serial BMD examination after alendronate treatment can be found. Thigh pain occurs after only 1.5 years of bisphosphonate treatment and it progresses to atypical fracture. Conclusions: Atypical fracture can occur in patients receive only short-term bisphosphonate treatment even BMD is still decreased after bisphosphonate treatment. Autoimmune disease, glucocorticoid treatment, Asian and female may be the possible risk factors.
Highlights
Bisphosphonates are widely accepted first line treatments for osteoporosis [1,2]
Though the efficacy in decreasing osteoporotic fracture risk is different between different bisphosphonate agents, they are proved to be able to decrease osteoporosis related fractures [2,3,4]
X-ray findings of this case meet all major features of atypical fracture that defined by Second Task Force Report of the American Society for Bone and Mineral Research [11]
Summary
Bisphosphonates are widely accepted first line treatments for osteoporosis [1,2]. Though the efficacy in decreasing osteoporotic fracture risk is different between different bisphosphonate agents, they are proved to be able to decrease osteoporosis related fractures [2,3,4]. Atypical fractures of femoral subtrochanter or shaft are reported to be one of the adverse effects after long-term treatment of bisphosphonates [1,2,5,6,7,8,9]. We will present a case of atypical fracture after only 1.5 years alendronate treatment. Drug holiday has been suggested for patients after longterm bisphosphonates treatment
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