Abstract
OBJECTIVE:
Despite the existence of numerous
case series, no evidenced-based medical management for atypical fractures
associated with bisphosphonate (BP) treatment has been established.
DESIGN:
We report the outcome of teriparatide
(TRP) administration followed by strontium ranelate (SR) in a woman with a
complete and an incomplete contralateral atypical fracture of the femoral
diaphysis (AFF) associated with BP treatment. The spontaneous complete AFF was
managed with intramedullary nailing, discontinuation of BP and initiation TRP.
RESULTS:
Eleven months later, she suffered a
contralateral incomplete AFF. At the completion of the TRP treatment, she had
only slight discomfort in the femur with the incomplete AFF. BMD testing
revealed increase of 7.61% at the lumbar spine (LS) and 0.8% at the hip.
Following TRP, 1-year SR treatment resulted in further BMD increase of 9.2% at
the LS and 1.4% in the hip, while she does not report any pain. Bone markers
remain within the normal range.
CONCLUSION:
Our case indicates that sequential therapy with TRP and SR
in cases of AFF might be a rational treatment option. However, there is a need for additional information
concerning the effect of TRP and SR, given alone or sequentially, in these
patients in order to incorporate these drugs into the management of AFF.
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