Case report: Osteomalacia due to bisphosphonate treatment in a patient on hemodialysis
Abstract Background No publications have reported on osteomalacia in patients receiving intermittent cyclical therapy with etidronate (a bisphosphonate) and undergoing long-term hemodialysis (HD). Case presentation We report on a 46-year-old Japanese man admitted to our hospital for further examinat...
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| Format: | Article |
| Language: | English |
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BMC
2021-09-01
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| Series: | BMC Nephrology |
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| Online Access: | https://doi.org/10.1186/s12882-021-02509-5 |
| _version_ | 1818734734569635840 |
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| author | Masaki Hatano Izuru Kitajima Seizo Yamamoto Masaki Nakamura Kazuya Isawa Yutaka Hirota Junichi Hoshino Naoki Sawa Yoshifumi Ubara |
| author_facet | Masaki Hatano Izuru Kitajima Seizo Yamamoto Masaki Nakamura Kazuya Isawa Yutaka Hirota Junichi Hoshino Naoki Sawa Yoshifumi Ubara |
| author_sort | Masaki Hatano |
| collection | DOAJ |
| description | Abstract Background No publications have reported on osteomalacia in patients receiving intermittent cyclical therapy with etidronate (a bisphosphonate) and undergoing long-term hemodialysis (HD). Case presentation We report on a 46-year-old Japanese man admitted to our hospital for further examination of left forearm pain. Maintenance HD was started at age 24 years, and the man had been on HD since then. At age 38 years, surgical parathyroidectomy was performed for secondary hyperparathyroidism; iliac crest bone biopsy performed at the same time showed osteitis fibrosa. The active vitamin D3 preparation calcitriol was started, and intermittent cyclical etidronate therapy was introduced 2 years later for osteoporosis. At age 45 years, the patient stopped taking calcitriol because of hypercalcemia but continued with etidronate. At age 46 years, a pseudofracture with a Looser zone occurred in the left ulna, and left femur bone biopsy revealed osteomalacia. Etidronate was discontinued, and calcitriol was restarted; open reduction and internal fixation with an angular stability plate were performed. Union of the bone was achieved 10 months after the operation. At age 49 years, a lumber bone biopsy confirmed improved bone morphometry. Conclusions We believe that intermittent cyclical etidronate therapy without administration of active vitamin D3 during long-term HD might have induced osteomalacia, resulting in the ulna insufficiency fracture. Therefore, we propose that administration of active vitamin D3 is essential to prevent osteomalacia in patients on long-term HD who are receiving bisphosphonates and have potential vitamin D3 deficiency. |
| first_indexed | 2024-12-18T00:10:04Z |
| format | Article |
| id | doaj.art-d057516a3d3b4826908ff4cec932951f |
| institution | Directory Open Access Journal |
| issn | 1471-2369 |
| language | English |
| last_indexed | 2024-12-18T00:10:04Z |
| publishDate | 2021-09-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Nephrology |
| spelling | doaj.art-d057516a3d3b4826908ff4cec932951f2022-12-21T21:27:42ZengBMCBMC Nephrology1471-23692021-09-012211810.1186/s12882-021-02509-5Case report: Osteomalacia due to bisphosphonate treatment in a patient on hemodialysisMasaki Hatano0Izuru Kitajima1Seizo Yamamoto2Masaki Nakamura3Kazuya Isawa4Yutaka Hirota5Junichi Hoshino6Naoki Sawa7Yoshifumi Ubara8Department of Orthopaedic Surgery, Toranomon Hospital KajigayaDepartment of Orthopaedic Surgery, Toranomon Hospital KajigayaDepartment of Orthopaedic Surgery, Toranomon Hospital KajigayaDepartment of Orthopaedic Surgery, Toranomon Hospital KajigayaDepartment of Orthopaedic Surgery, Toranomon Hospital KajigayaDepartment of Orthopaedic Surgery, Toranomon Hospital KajigayaDepartment of Nephrology Center, Toranomon Hospital KajigayaDepartment of Nephrology Center, Toranomon Hospital KajigayaDepartment of Nephrology Center, Toranomon Hospital KajigayaAbstract Background No publications have reported on osteomalacia in patients receiving intermittent cyclical therapy with etidronate (a bisphosphonate) and undergoing long-term hemodialysis (HD). Case presentation We report on a 46-year-old Japanese man admitted to our hospital for further examination of left forearm pain. Maintenance HD was started at age 24 years, and the man had been on HD since then. At age 38 years, surgical parathyroidectomy was performed for secondary hyperparathyroidism; iliac crest bone biopsy performed at the same time showed osteitis fibrosa. The active vitamin D3 preparation calcitriol was started, and intermittent cyclical etidronate therapy was introduced 2 years later for osteoporosis. At age 45 years, the patient stopped taking calcitriol because of hypercalcemia but continued with etidronate. At age 46 years, a pseudofracture with a Looser zone occurred in the left ulna, and left femur bone biopsy revealed osteomalacia. Etidronate was discontinued, and calcitriol was restarted; open reduction and internal fixation with an angular stability plate were performed. Union of the bone was achieved 10 months after the operation. At age 49 years, a lumber bone biopsy confirmed improved bone morphometry. Conclusions We believe that intermittent cyclical etidronate therapy without administration of active vitamin D3 during long-term HD might have induced osteomalacia, resulting in the ulna insufficiency fracture. Therefore, we propose that administration of active vitamin D3 is essential to prevent osteomalacia in patients on long-term HD who are receiving bisphosphonates and have potential vitamin D3 deficiency.https://doi.org/10.1186/s12882-021-02509-5BisphosphonateBone histomorphometryEtidronateHemodialysisOsteomalaciaCase report |
| spellingShingle | Masaki Hatano Izuru Kitajima Seizo Yamamoto Masaki Nakamura Kazuya Isawa Yutaka Hirota Junichi Hoshino Naoki Sawa Yoshifumi Ubara Case report: Osteomalacia due to bisphosphonate treatment in a patient on hemodialysis BMC Nephrology Bisphosphonate Bone histomorphometry Etidronate Hemodialysis Osteomalacia Case report |
| title | Case report: Osteomalacia due to bisphosphonate treatment in a patient on hemodialysis |
| title_full | Case report: Osteomalacia due to bisphosphonate treatment in a patient on hemodialysis |
| title_fullStr | Case report: Osteomalacia due to bisphosphonate treatment in a patient on hemodialysis |
| title_full_unstemmed | Case report: Osteomalacia due to bisphosphonate treatment in a patient on hemodialysis |
| title_short | Case report: Osteomalacia due to bisphosphonate treatment in a patient on hemodialysis |
| title_sort | case report osteomalacia due to bisphosphonate treatment in a patient on hemodialysis |
| topic | Bisphosphonate Bone histomorphometry Etidronate Hemodialysis Osteomalacia Case report |
| url | https://doi.org/10.1186/s12882-021-02509-5 |
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