Teraratide for the rapid resolution of delayed healing of atypical fractures associated wth long-term bisphosphonate use

MASTAGLIA SR; AGUILAR G; OLIVERI B

European Journal of Rheumatology

Board

Año: 2015

2147-9720

Bisphosphonates (BPs) are the most widely used drugs to treat osteoporosis. However, recent reports associated to long-term BPs use withatypical low-impact fractures and prodromal pain. It is estimated that 26% of the cases of atypical fractures associated with the long-termuse of BPs show delayed healing or nonunion. Teriparatide [PTH1-34] (TPTD) is an anabolic drug shown to be effective in stimulating boneformation. The aim was to describe the course of a right diaphyseal femoral fracture sustained by a patient on long-term BPs treatment.A 57-year-old postmenopausal Caucasian female presented with delayed healing of a right femoral diaphyseal fracture 10 months afterthe fracture, despite having received orthopedic treatment. The fracture was preceded by progressive, severe, and bilateral thigh pain.Her medical history included osteopenia that was treated with alendronate over 7 years. On presentation at our clinic, the patient ambulated with the aid of a walking cane. The diagnosis was an atypical right femoral fracture associated with long-term alendronate use.The levels of the following parameters were measured: mineral metabolism laboratory: intact parathormone, 40 ng/mL (reference values(rv): 10?65 ng/mL); 25-hydroxyvitamin D, 40 ng/mL (rv: >30 ng/mL); serum Crosslaps, 318 ng/mL (rv: 80?590 ng/mL); and bone-specificalkaline phosphatase, 76UI/L (rv: 31?95UI/L)]. Magnetic resonance imaging of the left femur was performed, which revealed a diaphysealstress fracture. She was prescribed 20 µg/day of subcutaneous (s.c.) TPTD (PTH1-34, Forteo; Eli Lilly Co., Indianapolis, IN, United States). Acomputed tomography scan performed 3 months later showed that the fracture had healed; the patient was able to resume her usualactivities. Twenty micrograms per day of s.c. TPD accelerated the healing of the atypical fracture associated with long-term alendronatetherapy, allowing a fast recovery of ambulation and quality of life.Keywords: Bisphosphonate, stress fracture, non-healing fracture, teriparatide