Iwata Ken, Mashiba Tasuku, Hitora Toshiaki, Yamagami Yoshiki, Yamamoto Tetsuji
Department of Orthopaedic Surgery, Kagawa University Faculty of Medicine, 1750-1 Ikenobe Mikicho, Kitagun, Kagawa 761-0793, Japan.
Bone. 2014 Jul;64:183-6. doi: 10.1016/j.bone.2014.04.012. Epub 2014 Apr 18.
A breast cancer patient developed an atypical femoral fracture after 9 years of bisphosphonate therapy for the treatment of multiple bone metastases. We histopathologically analyzed the femoral cortical bone at the fracture site and the iliac cancellous bone. Four months prior to the fracture, the patient had experienced pain in the right femur and underwent plain radiography and bone scintigraphy which revealed cortical thickening and radioisotope accumulation at each site, respectively. The patient had also experienced a non-traumatic fracture at the same site on the contralateral side 2 years earlier. Based on these findings, atypical femoral fracture was diagnosed and intramedullary nailing performed. A cortical bone specimen taken from near the fracture site during surgery showed marked microdamages, and analysis of the iliac cancellous bone specimen revealed severely suppressed bone turnover. These findings suggest that microdamage and severely suppressed bone turnover are associated with atypical femoral fracture reported in this patient with long-term bisphosphonate therapy.
一名乳腺癌患者在接受双膦酸盐治疗多发性骨转移9年后发生了非典型股骨骨折。我们对骨折部位的股骨皮质骨和髂骨松质骨进行了组织病理学分析。骨折前4个月，患者右侧股骨出现疼痛，并接受了X线平片和骨闪烁显像检查，结果分别显示每个部位的皮质增厚和放射性同位素聚集。该患者在2年前同一部位的对侧也曾发生过非创伤性骨折。基于这些发现，诊断为非典型股骨骨折并进行了髓内钉固定术。手术中从骨折部位附近采集的皮质骨标本显示有明显的微损伤，对髂骨松质骨标本的分析显示骨转换严重受抑。这些发现表明，微损伤和严重受抑的骨转换与该长期接受双膦酸盐治疗的患者所报告的非典型股骨骨折有关。
