Kim Hyo-Sang, Jung Han Young, Kim Myeong-Ok, Joa Kyung-Lim, Kim Yeo Ju, Kwon Su-Yeon, Kim Chang-Hwan
From the Department of Physical and Rehabilitation Medicine (H-SK, H-yJ, M-OK, K-LJ, S-YK, C-HK); and Department of Radiology (YJK), School of Medicine, Inha University, Incheon, Republic of Korea.
Medicine (Baltimore). 2015 Feb;94(5):e446. doi: 10.1097/MD.0000000000000446.
Bisphosphonates have been commonly used for the treatment of osteoporosis. However, there have been recent case reports of atypical fractures citing their long-term use, which inhibits the turnover of bone components. A 64-year-old woman visited the outpatient clinic with pain in her right thigh and ambulation difficulty. We found fractures at both pedicles of L4 vertebra. subtrochanteric region of right femur, and left femoral shaft upon a radiologic examination. She had taken intravenous ibandronic sodium for osteoporosis over 3 years. We changed the bishophonates to a parathyroid hormone because it was suspected that the multiple fractures were caused by the medication. Further, rehabilitation, including progressive weight bearing, was started. After 3 months of the conservative treatment, she was able to walk independently. In conclusion, it is necessary to evaluate the possibility of atypical fractures in osteoporotic patients when they complain of lower extremity pain and to consider alternative treatments instead of bisphosphonates.
双膦酸盐已被广泛用于治疗骨质疏松症。然而，最近有病例报告称，长期使用双膦酸盐会抑制骨成分的更新，从而导致非典型骨折。一名64岁女性因右大腿疼痛和行走困难前往门诊就诊。经放射学检查，我们发现她的L4椎体双侧椎弓根、右股骨转子下区域和左股骨干均发生骨折。她因骨质疏松症接受静脉注射伊班膦酸钠治疗已超过3年。由于怀疑多处骨折是由药物引起的，我们将双膦酸盐换成了甲状旁腺激素。此外，还开始了包括渐进性负重在内的康复治疗。经过3个月的保守治疗，她能够独立行走。总之，当骨质疏松症患者主诉下肢疼痛时，有必要评估非典型骨折的可能性，并考虑使用双膦酸盐以外的替代治疗方法。
