Department of Orthopedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College (CAMS & PUMC), Beijing, 100730, China.
Department of Endocrinology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College (CAMS & PUMC), Beijing, 100730, China.
Osteoporos Int. 2019 Nov;30(11):2349-2354. doi: 10.1007/s00198-019-05131-2. Epub 2019 Aug 19.
Bisphosphonates (BPs) are first-line drugs for the treatment of osteoporotic fractures, but long-term use of BP reduces bone turnover and is associated with atypical femur fractures (AFFs). Additionally, BP treatment may cause delayed fracture healing or nonunion, which makes AFF treatment difficult. The incidence of AFF is generally low. In fact, there are only a few clinical reports of AFF and there is no controlled study on AFF treatment. Herein, we report a case of multiple osteoporotic fractures. After 5 years of BP treatment, left and right AFFs occurred within 2 years. The fracture types and surgical operations were the same, but the level of bone metabolism and drug treatment were different. The right AFF healed well following teriparatide initiation compared with non-healed left AFF with BP continuation; thus, our case can be considered a self-controlled study. Furthermore, we have reviewed the diagnosis and treatment of this case in detail and analyzed and investigated the potential causes of the different outcomes of AFFs between the two sides to inform the clinical treatment of atypical fractures. Mini Abstract We report a case of bilateral AFFs. The surgical treatments were the same, but the final treatment outcomes were different with or without teriparatide treatment. We investigated the potential causes of the different outcomes of AFFs between the two sides to inform the clinical treatment of AFFs.
双膦酸盐（BPs）是治疗骨质疏松性骨折的一线药物，但长期使用 BP 会降低骨转换率，并与非典型股骨骨折（AFFs）相关。此外，BP 治疗可能导致骨折愈合延迟或不愈合，这使得 AFF 的治疗变得困难。AFF 的发病率一般较低。事实上，仅有少数关于 AFF 的临床报告，且没有关于 AFF 治疗的对照研究。在此，我们报告一例多发性骨质疏松性骨折病例。在 BP 治疗 5 年后，2 年内左右两侧均发生 AFF。骨折类型和手术操作相同，但骨代谢和药物治疗水平不同。与继续 BP 治疗而未愈合的左侧 AFF 相比，开始使用特立帕肽后右侧 AFF 愈合良好；因此，我们的病例可以被认为是一个自身对照研究。此外，我们详细回顾了该病例的诊断和治疗，并分析和探讨了两侧 AFF 不同结局的潜在原因，为 AFF 的临床治疗提供参考。
