Fukuda Fumio, Kurinomaru Naoaki, Hijioka Akihiko
Kitakyushu General Hospital, 5-10-10 Kokura-Minami, Kitakyushu, 800-0295, Japan.
Biol Ther. 2014 Dec;4(1-2):73-9. doi: 10.1007/s13554-014-0013-5. Epub 2014 Jan 29.
The occurrence of atypical femur fractures (AFFs) in patients on prolonged bisphosphonate treatment has been gaining medical attention, but the use of pharmacotherapy for these fractures has not been explored in detail. The authors describe a case of AFFs successfully treated with once-weekly administration of 56.5 μg teriparatide (TPTD).
The patient was a 74-year-old female patient who had been taking alendronate for approximately 6 years and who suffered with a fall while walking. X-rays revealed a subtrochanteric right femur fracture. The contralateral femur showed cortical thickening and a transverse radiolucent fracture line. Based on these specific features, the patient was diagnosed with AFF. The patient underwent osteosynthesis with intramedullary nailing for the right fracture. Alendronate treatment was discontinued. Low-intensity pulsed ultrasonography therapy did not affect the healing of the fracture with delayed union, even after 3 months of application. Prophylactic osteosynthesis was performed for the subtrochanteric left femur. Bone tissue collected from the left fracture site during surgery showed severe suppression of bone turnover. Union of bilateral femurs was achieved after 3 months of a once-weekly administration of TPTD.
Once-weekly TPTD treatment is shown to be beneficial for improving the healing of AFFs showing delayed union.
长期接受双膦酸盐治疗的患者发生非典型股骨骨折（AFFs）已引起医学界的关注，但针对这些骨折的药物治疗尚未得到详细研究。作者描述了一例通过每周一次给予56.5μg特立帕肽（TPTD）成功治疗的AFFs病例。
该患者为一名74岁女性，服用阿仑膦酸钠约6年，行走时摔倒。X线检查显示右股骨转子下骨折。对侧股骨显示皮质增厚及一条横向透光骨折线。基于这些特定特征，患者被诊断为AFFs。患者接受了右股骨骨折的髓内钉固定术。停用阿仑膦酸钠治疗。即使应用低强度脉冲超声治疗3个月后，骨折延迟愈合情况仍未改善。对左侧股骨转子下进行了预防性骨固定术。手术中从左侧骨折部位采集的骨组织显示骨转换严重受抑制。每周一次给予TPTD 3个月后双侧股骨均愈合。
每周一次的TPTD治疗被证明有利于改善延迟愈合的AFFs的愈合情况。
