Department of Orthopaedics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
Kaohsiung J Med Sci. 2012 Oct;28(10):555-8. doi: 10.1016/j.kjms.2012.04.019. Epub 2012 Aug 22.
Postmenopausal osteoporosis is commonly treated with alendronate, one of the bisphosphonates used for the prevention and treatment of osteoporotic fractures. However, the correlation between atypical femoral fractures and long-term bisphosphonate therapy has not been clearly identified. We report here the case of a 69-year-old woman with postmenopausal osteoporosis who presented with an atypical femoral subtrochanteric fracture on magnetic resonance imaging (MRI) confirmation after having received alendronate therapy for about 3 years. The fracture united after refixation and after administration of alendronate was stopped. Several published reports were reviewed, and some clinical characteristics of this atraumatic fracture were revealed, including the clinical symptoms of thigh pain, stress reaction or stress fracture, and transverse fracture with unicortical beak in an area of cortical hypertrophy. In addition to a regular radiographic survey, MRI, which may provide early information, and bone biopsy for pathologic analysis may be used as tools for early detection and final diagnosis. Once an insufficiency fracture is suspected or proved to be related to bisphosphonate, the withholding of bisphosphonate should be highly recommended to enhance fracture healing. Prophylactic fixation should be considered if fracture healing is not good or if the patient cannot tolerate protection of weight-bearing.
绝经后骨质疏松症通常采用阿仑膦酸钠进行治疗，阿仑膦酸钠属于双膦酸盐类药物，用于预防和治疗骨质疏松性骨折。然而，非典型股骨骨折与长期双膦酸盐治疗之间的相关性尚未明确。我们在此报告一例 69 岁绝经后骨质疏松症女性患者，在接受阿仑膦酸钠治疗约 3 年后，经磁共振成像（MRI）证实发生非典型股骨转子下骨折。骨折经再次固定和停用阿仑膦酸钠后愈合。我们回顾了一些已发表的报告，并揭示了这种非创伤性骨折的一些临床特征，包括大腿疼痛的临床症状、应激发应或应力性骨折，以及皮质肥厚区的横形骨折伴单皮质喙。除了定期进行影像学检查外，可能提供早期信息的 MRI 以及用于病理分析的骨活检可作为早期检测和最终诊断的工具。一旦怀疑或证实骨折与双膦酸盐有关，应强烈建议停用双膦酸盐，以促进骨折愈合。如果骨折愈合不良或患者无法耐受承重保护，则应考虑预防性固定。
