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Acta Clinica Belgica
International Journal of Clinical and Laboratory Medicine
Volume 74, 2019 - Issue 5
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Case Report

Conservative treatment of recurrent symptoms of an incomplete, atypical femoral fracture associated with glucocorticoid, bisphosphonate, and denosumab therapy in a patient with chronic obstructive pulmonary disease

, , ORCID Icon, ORCID Icon & ORCID Icon
Pages 370-374 | Published online: 19 Oct 2018
 

ABSTRACT

Background: Patients with chronic obstructive pulmonary disease have a high prevalence of osteoporosis, and different osteoporosis drugs are used to prevent fractures in these patients. Although the overall incidence of complete or incomplete, atypical femoral fracture (AFF) is low, long-term use of antiresorptive agents is associated with an increased risk of developing AFF.

Methods: We present a patient with chronic obstructive pulmonary disease with recurrent symptoms of an incomplete AFF who had been treated with glucocorticoids, and sequentially with alendronate, zoledronic acid, strontium ranelate, raloxifene, denosumab and finally with teriparatide. The first episode occurred before osteoporosis therapies, the second after bisphosphonate treatments, and the third under denosumab.

Results: Although her symptoms resolved along with gradually healing of fracture lines after conservative treatment without surgical intervention, progressive varus deformity of the proximal femur may have contributed to recurrence of AFF.

Conclusion: Early treatment with anabolic agents and prophylactic fixation of incomplete AFF may alleviate symptoms and prevent recurrences.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

The authors received no financial support for the work, authorship, and publication of this article.

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