Bisphosphonate-induced atypical femoral fracture in tandem: long-term follow-up is warranted
Although bisphosphonates (BPs) are mainly used for the treatment of osteoporosis and are generally safe, long-term use and more dosage as utilised in malignant conditions may be associated with the rare adverse event of an atypical femoral fracture (AFF). Occasionally, the risk of developing an AFF...
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| Format: | Article |
| Language: | English |
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Bioscientifica
2022-08-01
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| Series: | Endocrinology, Diabetes & Metabolism Case Reports |
| Online Access: | https://edm.bioscientifica.com/view/journals/edm/2022/1/EDM22-0249.xml |
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| author | Mohammed Anwar Hussain Aneez Joseph Vinoo Mathew Cherian Alok Srivastava Kripa Elizabeth Cherian Nitin Kapoor Thomas Vizhalil Paul |
| author_facet | Mohammed Anwar Hussain Aneez Joseph Vinoo Mathew Cherian Alok Srivastava Kripa Elizabeth Cherian Nitin Kapoor Thomas Vizhalil Paul |
| author_sort | Mohammed Anwar Hussain |
| collection | DOAJ |
| description | Although bisphosphonates (BPs) are mainly used for the treatment of osteoporosis and are generally safe, long-term use and more dosage as utilised in malignant conditions may be associated with the rare adverse event of an atypical femoral fracture (AFF). Occasionally, the risk of developing an AFF persists long after BPs are withdrawn. A 39-year-old woman who underwent chemotherapy and an autologous stem cell transplantation for multiple myeloma presented to us with history of pain in the left thigh. She had received multiple doses of oral and parenteral BPs for about 10 years in view of the underlying myeloma with osteoporosis. Her investigations showed a suppressed CTX of 192 pg/mL, and radiograph of pelvis displayed thickened cortices with beaking of the left femoral shaft, which was suggestive of an AFF. Following discontinuation of BPs, she underwent prophylactic intra-medullary nailing with which her symptoms improved. Five years later, she presented with similar complaints on the right side. Investigations showed that her bone turnover continued to be suppressed with Cross linked C- Telopeptide of type 1 collagen (CTX) of 165 pg/mL and an X-ray done showed AFF on the right side despite being off BPs. A second intra-medullary nailing was done and on follow-up, she has been symptom-free and independent in her daily activities. Discontinuation of BPs may not prevent the incident second AFF and, therefore, thus warranting long-term follow-up. |
| first_indexed | 2024-04-14T02:41:51Z |
| format | Article |
| id | doaj.art-f012277ee4c24783acce642260f33063 |
| institution | Directory Open Access Journal |
| issn | 2052-0573 |
| language | English |
| last_indexed | 2024-04-14T02:41:51Z |
| publishDate | 2022-08-01 |
| publisher | Bioscientifica |
| record_format | Article |
| series | Endocrinology, Diabetes & Metabolism Case Reports |
| spelling | doaj.art-f012277ee4c24783acce642260f330632022-12-22T02:16:52ZengBioscientificaEndocrinology, Diabetes & Metabolism Case Reports2052-05732022-08-01111510.1530/EDM-22-0249Bisphosphonate-induced atypical femoral fracture in tandem: long-term follow-up is warrantedMohammed Anwar Hussain0Aneez Joseph1Vinoo Mathew Cherian2Alok Srivastava3Kripa Elizabeth Cherian4Nitin Kapoor5Thomas Vizhalil Paul6Department of EndocrinologyDepartment of EndocrinologyDepartment of OrthopaedicsDepartment of Haematology, Christian Medical College and Hospital, Vellore, IndiaDepartment of EndocrinologyDepartment of EndocrinologyDepartment of EndocrinologyAlthough bisphosphonates (BPs) are mainly used for the treatment of osteoporosis and are generally safe, long-term use and more dosage as utilised in malignant conditions may be associated with the rare adverse event of an atypical femoral fracture (AFF). Occasionally, the risk of developing an AFF persists long after BPs are withdrawn. A 39-year-old woman who underwent chemotherapy and an autologous stem cell transplantation for multiple myeloma presented to us with history of pain in the left thigh. She had received multiple doses of oral and parenteral BPs for about 10 years in view of the underlying myeloma with osteoporosis. Her investigations showed a suppressed CTX of 192 pg/mL, and radiograph of pelvis displayed thickened cortices with beaking of the left femoral shaft, which was suggestive of an AFF. Following discontinuation of BPs, she underwent prophylactic intra-medullary nailing with which her symptoms improved. Five years later, she presented with similar complaints on the right side. Investigations showed that her bone turnover continued to be suppressed with Cross linked C- Telopeptide of type 1 collagen (CTX) of 165 pg/mL and an X-ray done showed AFF on the right side despite being off BPs. A second intra-medullary nailing was done and on follow-up, she has been symptom-free and independent in her daily activities. Discontinuation of BPs may not prevent the incident second AFF and, therefore, thus warranting long-term follow-up.https://edm.bioscientifica.com/view/journals/edm/2022/1/EDM22-0249.xml |
| spellingShingle | Mohammed Anwar Hussain Aneez Joseph Vinoo Mathew Cherian Alok Srivastava Kripa Elizabeth Cherian Nitin Kapoor Thomas Vizhalil Paul Bisphosphonate-induced atypical femoral fracture in tandem: long-term follow-up is warranted Endocrinology, Diabetes & Metabolism Case Reports |
| title | Bisphosphonate-induced atypical femoral fracture in tandem: long-term follow-up is warranted |
| title_full | Bisphosphonate-induced atypical femoral fracture in tandem: long-term follow-up is warranted |
| title_fullStr | Bisphosphonate-induced atypical femoral fracture in tandem: long-term follow-up is warranted |
| title_full_unstemmed | Bisphosphonate-induced atypical femoral fracture in tandem: long-term follow-up is warranted |
| title_short | Bisphosphonate-induced atypical femoral fracture in tandem: long-term follow-up is warranted |
| title_sort | bisphosphonate induced atypical femoral fracture in tandem long term follow up is warranted |
| url | https://edm.bioscientifica.com/view/journals/edm/2022/1/EDM22-0249.xml |
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