Yeh Wen-Ling, Su Chun-Yi, Chang Chia-Wei, Chen Chien-Hao, Fu Tsai-Sheng, Chen Lih-Huei, Lin Tung-Yi
Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Keelung branch, Bone and Joint Research Center, and Chang Gung University,, Taiwan, F7, No 222 Mai-King Road, Keelung, Taiwan.
Department of Orthopedic Surgery, Division of Trauma, Chang Gung Memorial Hospital, Linkou branch, Bone and Joint Research Center and Chang Gung University, Taoyuan, Taiwan.
BMC Musculoskelet Disord. 2017 Dec 13;18(1):527. doi: 10.1186/s12891-017-1878-5.
Atypical subtrochanteric fracture and femoral fracture have been considered to be rare complications related to long-term bisphosphonates use. A reduced bone turnover rate may lead to delayed bone healing. Limited data have revealed that teriparatide treatment may reverse the effect of bisphosphonates and be effective in bone healing.
We reviewed patients with atypical subtrochanteric and femoral fracture related to bisphosphonates use between January 2008 and December 2014. Thirteen female patients were enrolled. Radiographic findings were compatible with the characteristics of atypical fracture. Surgical intervention was performed for all, and teriparatide use was advised postoperatively. Outcome measures included perioperative results, and clinical and radiographic outcome.
Of the 13 female patients enrolled, 10 had subtrochanteric and 6 had proximal femoral fracture; 3 had bilateral fractures. The mean age of the patients at surgery was 70.15±6.36 years. Most fractures (68.8%) presented prodromal thigh pain. All patients were treated with an intramedullary fixation system without severe complications. The patients were divided into 2 groups based on whether they had received treatment with teriparatide or not. The mean time to bone union was 4.4 months in the teriparatide-treated group, and 6.2 months in the non-teriparatide-treated group (p=0.116). Six patients (75%) in the teriparatide-treated group and 4 (50%) in the non-teriparatide-treated group (p= 0.3) achieved bone union within 6 months. The means of the modified Harris Hip Score and Numerical Rating Scale were significantly better in the teriparatide-treated group at postoperative 6 months. Seven patients had the same ability to walk at the 1-year follow-up as they did before the atypical fracture.
Teriparatide treatment in patients with atypical fracture may help in fracture healing, hip function recovery, and pain relief in this reduced bone turnover patient group.
非典型转子下骨折和股骨骨折被认为是长期使用双膦酸盐类药物的罕见并发症。骨转换率降低可能导致骨愈合延迟。有限的数据显示，特立帕肽治疗可能会逆转双膦酸盐类药物的作用，并对骨愈合有效。
我们回顾了2008年1月至2014年12月期间因使用双膦酸盐类药物而发生非典型转子下和股骨骨折的患者。纳入了13名女性患者。影像学表现符合非典型骨折的特征。所有患者均接受了手术干预，并建议术后使用特立帕肽。观察指标包括围手术期结果、临床和影像学结果。
在纳入的13名女性患者中，10例为转子下骨折，6例为股骨近端骨折；3例为双侧骨折。患者手术时的平均年龄为70.15±6.36岁。大多数骨折（68.8%）表现为前驱性大腿疼痛。所有患者均接受髓内固定系统治疗，无严重并发症。根据患者是否接受特立帕肽治疗将其分为两组。特立帕肽治疗组的平均骨愈合时间为4.4个月，未接受特立帕肽治疗组为6.2个月（p=0.116）。特立帕肽治疗组6例（75%）患者和未接受特立帕肽治疗组4例（50%）患者在6个月内实现了骨愈合（p=0.3）。术后6个月，特立帕肽治疗组的改良Harris髋关节评分和数字评定量表的平均值明显更好。7例患者在1年随访时的行走能力与非典型骨折前相同。
在这个骨转换率降低的患者群体中，特立帕肽治疗非典型骨折患者可能有助于骨折愈合、髋关节功能恢复和疼痛缓解。
