Alabbasi Alwaleed, Moloney Darren P, Murariu Costel M, Khan Sami U
Royal College of Surgeons in Ireland, Dublin, Ireland.
Royal College of Surgeons in Ireland, Dublin, Ireland
BMJ Case Rep. 2025 Jun 12;18(6):e265400. doi: 10.1136/bcr-2025-265400.
Atypical femur fractures (AFFs) are rare complications of antiresorptive therapies like denosumab, resulting from suppressed bone remodelling. These fractures occur with minimal or no trauma and are often preceded by prodromal thigh or groin pain. Radiographically, they present as transverse or short oblique fractures with lateral cortical thickening and minimal comminution.We report a case of an elderly bisphosphonate-naïve patient on denosumab who developed a subtrochanteric AFF. The patient underwent intramedullary nailing, denosumab was discontinued, and a transition to bisphosphonates was planned after 6 months to reduce the risk of rebound vertebral fractures. Histological analysis confirmed cortical bone fragments with no malignancy, consistent with AFF pathology.This case highlights the importance of early recognition of AFFs, appropriate surgical intervention and careful management of antiresorptive therapies. It also highlights the need for vigilant monitoring in long-term denosumab patients and provides valuable insights into the management of these fractures.
非典型股骨骨折（AFFs）是地诺单抗等抗吸收治疗罕见的并发症，由骨重塑受抑制所致。这些骨折在极少或无创伤情况下发生，且常在出现前驱性大腿或腹股沟疼痛之后出现。在影像学上，它们表现为伴有外侧皮质增厚和极少粉碎的横行或短斜行骨折。我们报告一例老年患者，该患者未使用过双膦酸盐类药物，正在接受地诺单抗治疗，发生了转子下非典型股骨骨折。患者接受了髓内钉固定，停用了地诺单抗，并计划在6个月后改用双膦酸盐类药物，以降低椎体骨折反弹的风险。组织学分析证实皮质骨碎片无恶性肿瘤，符合非典型股骨骨折的病理特征。该病例突出了早期识别非典型股骨骨折、进行适当手术干预以及谨慎管理抗吸收治疗的重要性。它还强调了对长期使用地诺单抗患者进行密切监测的必要性，并为这些骨折的管理提供了有价值的见解。
