Division of Bone and Mineral Diseases, Washington University School of Medicine, St. Louis, MO, USA.
Osteoporos Int. 2010 Apr;21(4):705-8. doi: 10.1007/s00198-009-1012-0. Epub 2009 Aug 11.
Reports of femoral shaft fractures in patients on long-term bisphosphonates (BPs) have raised important concerns on the safety for this class of drugs. Patients with malignancies are potentially at a higher risk for this complication considering the dose and the duration of treatment with BPs. In this report we describe the case of 56-year-old woman with multiple myeloma who developed a non-traumatic left femoral shaft fracture after treatment with high dose BPs for 6 years, following a bone marrow transplant. Intramedullary rod fixation of the fractured femur resulted in "splitting" of the fractured bone followed by poor healing and nonunion of the fractured bone. This case illustrates a potential problem in the management of patients with femoral shaft fractures from prolonged BPs, most especially those who are on high doses for malignant conditions. However, considering the number of patients who benefit from BPs, this complication should not discourage clinicians from using these agents in patients where treatment is indicated.
长期使用双膦酸盐（BPs）的患者发生股骨骨干骨折的报告引起了人们对这类药物安全性的高度关注。考虑到 BPs 的剂量和治疗持续时间，患有恶性肿瘤的患者发生这种并发症的风险更高。在本报告中，我们描述了一例 56 岁女性多发性骨髓瘤患者的病例，该患者在骨髓移植后接受了 6 年高剂量 BPs 治疗后发生了非外伤性左侧股骨骨干骨折。骨折股骨的髓内棒固定导致骨折骨“分裂”，随后骨折骨愈合不良和不愈合。该病例说明了在处理因长期使用 BPs 引起的股骨骨干骨折患者时存在的潜在问题，尤其是那些因恶性疾病而接受高剂量治疗的患者。然而，考虑到受益于 BPs 的患者数量，这种并发症不应阻止临床医生在治疗指征明确的情况下使用这些药物。
