Case Report

Fractures in Corticosteroid- and Bisphosphonate-Treated Subjects With Longstanding Rheumatoid Arthritis and Systemic Lupus Erythematosus

Abstract

Background: Bisphosphonates are the most widely prescribed agents for the treatment of postmenopausal osteoporosis and other metabolic bone diseases. Atypical femoral fractures in bisphosphonate-treated patients have raised concerns regarding the long-term safety of this class of medications.

Case Presentation: In this study, we report two patients suffering from fractures while receiving biphosphonates; a postmenopausal patient with rheumatoid arthritis and a history of long-term use of bisphosphonates and glucocorticoids presenting with multiple fractures as case one and another 52-year-old female patient diagnosed with Systemic Lupus Erythematosus (SLE) who suffered from a femoral shaft fracture without any history of prior traumatic incidents as case two.

Conclusions: Considering the low risk for atypical femoral fractures, further careful screening for these types of fractures should be undertaken. In addition, in order to lower the rate of fractures in patients on long-term bisphosphonate therapy, assessment of patients’ contralateral side should be considered to prevent further fractures, especially in patients with prodromal pain

 

[1] Kayali C, Altay T, Ozan F, Sozkesen S, Yamak K. Atypical femoral shaft fractures secondary to long-term bisphosphonate therapy. Journal of Orthopaedics. 2017; 14(2):226-30. [DOI:10.1016/j. jor.2017.01.002] [PMID] [PMCID]
[2] Kang JS, Won YY, Kim JO, Min BW, Lee KH, Park KK, et al. Atypical femoral fractures after anti-osteoporotic medication: A Korean multicenter study. International Orthopaedics. 2014; 38(6):1247-53. [DOI:10.1007/s00264-013-2259-9] [PMID] [PMCID]
[3] Khan AA, Kaiser S. Atypical femoral fracture. Canadian Medical Association Journal. 2017; 189(14):E542. [DOI:10.1503/cmaj.160450] [PMID] [PMCID]
[4] Donnelly E, Saleh A, Unnanuntana A, Lane JM. Atypical femoral fractures: epidemiology, etiology, and patient management. Current Opinion in Supportive and Palliative Care. 2012; 6(3):348-54. [DOI:10.1097/SPC.0b013e3283552d7d] [PMID] [PMCID]
[5] Hong CH, Quach A, Lin L, Olson J, Kwon T, Bezouglaia O, et al. Local vs. Systemic administration of bisphosphonates in rat cleft bone graft: A comparative study. PLoS One. 2018; 13(1):e0190901. [DOI: 10.1371/journal.pone.0190901] [PMID] [PMCID]
[6] Saita Y, Ishijima M, Kaneko K. Atypical femoral fractures and bisphosphonate use: Current evidence and clinical implications. Therapeutic Advances in Chronic Disease. 2015; 6(4):185-93. [DOI:10.1177/2040622315584114] [PMID] [PMCID]
[7] Koehne T, Kahl-Nieke B, Amling M, Korbmacher-Steiner H. Inhibition of bone resorption by bisphosphonates interferes with orthodontically induced midpalatal suture expansion in mice. Clinical Oral Investigations. 2018; 22(6):2345-51. [DOI:10.1007/s00784- 018-2335-z] [PMID]
[8] Yamamoto N. Atypical femoral fracture and Bisphosphonate. Clinical Calcium.2017; 27(2):233-8. [PMID]
[9] Qiu S, Divine GW, Palnitkar S, Kulkarni P, Guthrie TS, Honasoge M, et al. Bone structure and turnover status in postmenopausal women with atypical femur fracture after prolonged bisphosphonate therapy. Calcified Tissue International. 2017; 100(3):235-43. [DOI:10.1007/s00223-016-0223-6] [PMID] [PMCID]
[10] Kim SY, Schneeweiss S, Katz JN, Levin R, Solomon DH. Oral bisphosphonates and risk of subtrochanteric or diaphyseal femur fractures in a population-based cohort. Journal of Bone and Mineral Research. 2011; 26(5):993-1001. [DOI:10.1002/jbmr.288] [PMID] [PMCID]
[11] Gedmintas L, Solomon DH, Kim SC. Bisphosphonates and risk of subtrochanteric, femoral shaft, and atypical femur fracture: A systematic review and meta-analysis. Journal of Bone and Mineral Research. 2013; 28(8):1729-37. [DOI:10.1002/jbmr.1893] [PMID] [PMCID]
[12] Lee YK, Ahn S, Kim KM, Suh CS, Koo KH. Incidence rate of atypical femoral fracture after bisphosphonates treatment in Korea. Journal of Korean Medical Sciences. 2018; 33(5):e38. [DOI:10.3346/ jkms.2018.33.e38] [PMID] [PMCID]
[13] Lovy AJ, Patterson D, Skeeles L, Ghillani R, Joseph D, Wu Y, et al. Atraumatic segmental atypical femur fracture secondary to bisphosphonate use: A case report. Journal of Clinical Orthopaedics and Trauma. 2017; 8(1):S67-71. [DOI:10.1016/j.jcot.2017.03.005] [PMID] [PMCID]
[14] Bubbear JS. Atypical femur fractures in patients treated with bisphosphonates: Identification, management, and prevention. Rambam Maimonides Medical Journal. 2016; 7(4):e0032 [DOI:10.5041/ RMMJ.10259] [PMID] [PMCID]
[15] Eisenstein N, Kasavkar G, Bhavsar D, Khan FS, Paskins Z. Incidence and medical management of bisphosphonate-associated atypical femoral fractures in a major trauma centre: A retrospective observational study. BMC Musculoskeletal Disorders. 2017; 18(1):29. [DOI:10.1186/s12891-017-1392-9] [PMID] [PMCID]
[16] Maheshwari AV, Yarmis SJ, Tsai J, Jauregui JJ. Progression of bisphosphonate-associated impending atypical femoral fracture despite prophylactic cephalomedullary nailing: A case report and review
of literature. Journal of Clinical Orthopaedics and Trauma. 2016; 7(Suppl 1):92-8. [DOI:10.1016/j.jcot.2016.06.003] [PMID] [PMCID]
[17] Mir SA, Alanii FM. Long-term use of bisphosphonates in osteoporosis. Saudi Medical Journal. 2017; 38(8):873-4. [DOI:10.15537/ smj.2017.8.20748 ] [PMID] [PMCID]
[18] Găleşanu C, Mocanu V, Buzdugă C, Florescu A, Zaharia V, Lisnic V. Atypical femoral fractures after long-term bisphosphonates therapy: Case report. Bone Abstracts. 2016; 5:386. [DOI:10.1530/ boneabs.5.P386]
Files
IssueVol 6 No 2 (2021): Mar/Apr QRcode
SectionCase Report(s)
Published2021-08-07
DOI https://doi.org/10.18502/crcp.v6i2.6683
Keywords
Fracture Rheumatoid arthritis Biphosphonates

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How to Cite
1.
Moghtadaie A, Miratashi Yazdi SA, Salimzadeh A. Fractures in Corticosteroid- and Bisphosphonate-Treated Subjects With Longstanding Rheumatoid Arthritis and Systemic Lupus Erythematosus. CRCP. 2021;6(2):59-65.