Uppin Rajendra, Gupta Srinath, Prakash Shivank
Department of Orthopaedics, J.N. Medical College, KLE University, Belgaum, Karnataka, India.
J Orthop Case Rep. 2016 Sep-Oct;6(4):31-34. doi: 10.13107/jocr.2250-0685.558.
Osteoporosis is a significant health-care problem characterized by excessive skeletal fragility, susceptibility to low-trauma fractures in men as well as women. Any abnormality of the bone that reduces the strength of the bone predisposes it to mechanical failure during normal activity or with minimum trauma. The mechanical failure manifests itself as a fracture, and this fracture must be recognized as a pathological fracture if the patient is to be treated properly. Osteoporosis is one of the leading causes of such pathological fractures and accounts for 1.5 million fractures annually. In the following case report, we present a 56-year-old postmenopausal female patient with bilateral pathological subtrochanteric fracture femurii due to intake of bisphosponates for 4 years for osteoporosis. Bilateral pathological subtrochanteric femurii fractures are extremely uncommon injuries which occur in adults who sustain injuries due to trivial trauma. A variety of management modalities has been tried to treat this complex fracture pattern. Standard fixation treatment is intramedullary nailing.
A postmenopausal female of rheumatoid arthritis aged 56 years, presented to our emergency department with a history of trivial fall at home. Following the fall, she was unable to bear weight on bilateral feet and complained of deformity. History revealed consumption of bisphosphonates (tablet alendronate 10 mg) for the last 4 years and glucocorticoids for rheumatiod arthritis. Radiographs were taken, which revealed bilateral pathological subtrochanteric fracture femurii. After obtaining necessary fitness, the patient was taken up for surgery. Closed reduction and Internal fixation with long proximal femoral nail were done. Bisphosphonate intake was stopped and teriparatide 20 µg/day subcutaneously given for 3 months. Fracture healed after 3 months and patient resumed her daily activities.
In people taking long-term bisphoshponate therapy, symptomatic cortical stress reactions accompanied by evidence of a stress line across the cortical thickening suggest an increased risk of a complete stress fracture. The patients should be informed about the prodromal symptoms like pain and swelling, following this bisphosphonates should be stopped and teriparatide has to be started for osteoporosis.
骨质疏松是一个重大的医疗保健问题，其特征是骨骼极度脆弱，男性和女性都易发生低创伤性骨折。任何降低骨骼强度的骨骼异常都会使其在正常活动或受到最小创伤时易于发生机械性衰竭。机械性衰竭表现为骨折，如果要对患者进行正确治疗，这种骨折必须被认定为病理性骨折。骨质疏松是此类病理性骨折的主要原因之一，每年导致150万例骨折。在以下病例报告中，我们介绍了一名56岁的绝经后女性患者，因服用双膦酸盐类药物治疗骨质疏松4年，发生双侧股骨转子下病理性骨折。双侧股骨转子下病理性骨折是极其罕见的损伤，发生于因轻微创伤而受伤的成年人。人们尝试了多种治疗方式来处理这种复杂的骨折类型。标准的固定治疗方法是髓内钉固定。
一名56岁患类风湿关节炎的绝经后女性因在家中轻微跌倒前来我院急诊科就诊。跌倒后，她双足无法负重，并诉说有畸形。病史显示其在过去4年中服用双膦酸盐类药物（阿仑膦酸钠片10毫克）以及用于治疗类风湿关节炎的糖皮质激素。拍摄了X线片，显示双侧股骨转子下病理性骨折。在获得必要的身体状况评估后，患者接受了手术。进行了闭合复位并用股骨近端加长髓内钉进行内固定。停止服用双膦酸盐类药物，并皮下注射特立帕肽每日20微克，持续3个月。3个月后骨折愈合，患者恢复了日常活动。
在长期接受双膦酸盐治疗的人群中，有症状的皮质骨应力反应伴有皮质增厚处应力线的证据提示完全性应力性骨折的风险增加。应告知患者有关疼痛和肿胀等前驱症状，此后应停用双膦酸盐类药物，并开始使用特立帕肽治疗骨质疏松。
