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

Kun Hung Lai, Chih Yung Chiang, Rong Sen Yang, Kai Chiang Yang, Chang Chin Wu

Research output: Contribution to journalArticle

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.

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Femoral Fractures
Diphosphonates
Chronic Obstructive Pulmonary Disease
Glucocorticoids
Osteoporosis
zoledronic acid
strontium ranelate
Teriparatide
Bone Density Conservation Agents
Therapeutics
Anabolic Agents
Alendronate
Recurrence
Fracture Healing
Femur
Denosumab
Conservative Treatment
Incidence
Pharmaceutical Preparations

Keywords

  • atypical femoral fracture
  • bisphosphonate
  • Chronic obstructive pulmonary disease
  • denosumab
  • glucocorticoid
  • incomplete

ASJC Scopus subject areas

  • Medicine(all)

Cite this

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title = "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",
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.",
keywords = "atypical femoral fracture, bisphosphonate, Chronic obstructive pulmonary disease, denosumab, glucocorticoid, incomplete",
author = "Lai, {Kun Hung} and Chiang, {Chih Yung} and Yang, {Rong Sen} and Yang, {Kai Chiang} and Wu, {Chang Chin}",
year = "2019",
doi = "10.1080/17843286.2018.1534576",
language = "English",
journal = "Acta Clinica Belgica",
issn = "0001-5512",
publisher = "Acta Clinica Belgica",

}

TY - JOUR

T1 - 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

AU - Lai, Kun Hung

AU - Chiang, Chih Yung

AU - Yang, Rong Sen

AU - Yang, Kai Chiang

AU - Wu, Chang Chin

PY - 2019

Y1 - 2019

N2 - 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.

AB - 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.

KW - atypical femoral fracture

KW - bisphosphonate

KW - Chronic obstructive pulmonary disease

KW - denosumab

KW - glucocorticoid

KW - incomplete

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DO - 10.1080/17843286.2018.1534576

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