Department of Emergency and Critical Care Medicine, University of Tsukuba Hospital, 2-1-1 Amakubo, Tsukuba, Ibaraki, 305-8576, Japan.
Department of Orthopaedic Surgery, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan.
J Med Case Rep. 2023 Jun 21;17(1):257. doi: 10.1186/s13256-023-03999-7.
Denosumab therapy is often used to reduce skeletal-related events in metastatic bone disease. On the other hand, there have been some instances of atypical femoral fracture in patients with metastatic bone disease treated with denosumab. In this case report, we describe a patient with metastatic bone disease due to breast cancer who had been using denosumab for 4 years to prevent skeletal-related events and suffered an atypical tibial fracture.
We report here the case of an 82-year-old Japanese woman who had received yearly intravenous denosumab for 4 years and presented with a fracture fulfilling the criteria for an atypical fracture, except for being located at the tibial diaphysis. She was found to have stage 4 breast cancer with multiple bone metastases 4 years prior. She had difficulty walking due to her tibial pain and underwent surgical treatment. Four months after surgery, the tibial fracture site exhibited bone fusion.
In patients with long-term use of denosumab to prevent skeletal-related events in metastatic bone disease, it is important to be aware of shin and thigh pain and to examine for signs of atypical tibial fractures to pay attention to atypical femoral fractures.
地舒单抗治疗常用于减少转移性骨病中的骨骼相关事件。另一方面，在接受地舒单抗治疗的转移性骨病患者中，已经出现了一些非典型股骨骨折的情况。在本病例报告中，我们描述了一名患有乳腺癌转移性骨病的患者，该患者使用地舒单抗预防骨骼相关事件已达 4 年，发生了非典型胫骨骨折。
我们在此报告一例 82 岁日本女性患者，她已接受每年一次的静脉内用地舒单抗治疗 4 年，并出现了符合非典型骨折标准的骨折，只是部位位于胫骨骨干。4 年前，她被诊断为 4 期乳腺癌，伴多处骨转移。由于胫骨疼痛，她行走困难，并接受了手术治疗。手术后 4 个月，胫骨骨折部位出现骨融合。
对于长期使用地舒单抗预防转移性骨病中的骨骼相关事件的患者，注意胫骨和大腿疼痛，并检查是否存在非典型胫骨骨折的迹象，以关注非典型股骨骨折，这一点很重要。
