Division of Endocrinology, Agamenon Magalhães Hospital, University of Pernambuco Medical School, 52061-540 Recife, Brazil.
J Clin Endocrinol Metab. 2011 Sep;96(9):2675-80. doi: 10.1210/jc.2011-0593. Epub 2011 Jul 13.
Atypical femoral fractures have rarely been reported in women taking bisphosphonates, but this is still a controversial issue. Data are derived mainly from observation studies because a post hoc analysis from a randomized clinical trial did not find any such association.
The aim of this study was to report three cases of what are considered atypical femoral fractures and their responses to the use of strontium ranelate and teriparatide.
We studied three postmenopausal women with a diagnosis of osteoporosis who suffered fractures of the subtrochanteric region and femoral diaphysis with no major trauma while on long-term use of bisphosphonates.
All the major features of atypical femoral fractures highlighted in the Task Force Report of the American Society for Bone and Mineral Research were present in the three cases. They had had unconsolidated fractures for approximately 1 yr before being referred to our center. After 3 months on strontium ranelate 2 g/d, serum osteocalcin and serum β-carboxyterminal telopeptide had increased in case 1 by 125 and 100%, respectively, and in case 2 by 50 and 22%, respectively, with total closure of the fracture. In case 3, after 1 month on teriparatide 20 μg/d, a radiographic closure of the fracture was achieved, and 3 months later serum osteocalcin and serum β-carboxyterminal telopeptide had increased by 300 and 22%, respectively.
Our finding showed that both teriparatide and strontium ranelate had a rapid bone anabolic effect on unhealed atypical fractures associated with chronic bisphosphonate use.
接受双膦酸盐治疗的女性中，偶发性股骨骨折的报道罕见，但这仍然是一个存在争议的问题。这些数据主要来源于观察性研究，因为一项随机临床试验的事后分析并未发现任何此类相关性。
本研究旨在报告三例被认为是偶发性股骨骨折的病例，以及它们对锶雷奈酸和特立帕肽使用的反应。
我们研究了 3 名绝经后骨质疏松症女性患者，她们在长期使用双膦酸盐的情况下，无明显外伤而发生了股骨转子下区域和骨干骨折。
所有美国骨骼与矿物质研究协会工作组报告中强调的偶发性股骨骨折的主要特征均存在于这 3 例病例中。在被转至我们中心之前，她们的主要骨折已经愈合了大约 1 年。在开始使用锶雷奈酸 2 g/d 治疗 3 个月后，病例 1 的血清骨钙素和血清 β-羧基端肽分别增加了 125%和 100%，病例 2 分别增加了 50%和 22%，骨折完全愈合。在病例 3 中，开始使用特立帕肽 20 μg/d 治疗 1 个月后，骨折的影像学表现得到了愈合，3 个月后血清骨钙素和血清 β-羧基端肽分别增加了 300%和 22%。
我们的发现表明，特立帕肽和锶雷奈酸对与慢性双膦酸盐使用相关的未愈合的偶发性骨折均具有快速的骨合成作用。
