INVESTIGADORES
OLIVERI Maria Beatriz
congresos y reuniones científicas
Título:
Rapid resolution with teriparatide in delayed healing of atypical fracture associated to long -term bisphosphonate
Autor/es:
SILVINA MASTAGLIA; GABRIEL AGUILAR; BEATRIZ OLIVERI *
Lugar:
Roma
Reunión:
Congreso; European Congress of Osteoporosis and Osteoarthritis; 2013
Institución organizadora:
International osteoprosis Foundation
Resumen:
Bisphosphonates are the drugs most widely used to treat osteoporosis due to their efficiency in reducing osteoporotic fractures and improving bone mineral density (BMD). However, recent reports associate long-term bisphosphonates use with low-impact atypical fractures and prodromal pain1. Delayed fracture healing was observed in 26% of the cases1. Teriparatide is an anabolic drug which has shown to be effective in stimulating bone formation. Purpose: To describe a patient’s clinical course when treated with alendronate over a long period, having developed a right femoral diaphyseal fracture with a delayed healing fracture, rapidly healed with teriparatide. Case Report: A 57-yr-old postmenopausal Caucasian female, with a delayed healing of her right femoral diaphyseal fracture, after 10 months, despite of an orthopedic treatment. Her fracture had been preceded by a 9-month progressive, bilateral and severe pain in thighs. Her medical history included a vulvar cancer at 44, osteoarthrosis and osteopenia treated with alendronate over 7 yrs. Menopause at 49. Her family history did not include any a maternal fragility fracture. She never smoked or consumed alcohol excessively. In first visit, she was using a walking-stick. It was considered as an atypical right femoral fracture associated to long-term alendronate use. According to this information alendronate was suspended. The following studies were performed: bone densitometry [(DXA, Lunar Prodigy, Madison, USA): Lumbar Spine (L2-L4): 0.912g/cm2; T-score: -2.4 and Left Total Femur: 0.805g/cm2; T-score: -1.6]; mineral metabolism laboratory iPTH: 40ng/ml (rv:10-65ng/ml), 25OHD: 40ng/ml (rv:>30ng/ml); sCTX: 318 ng/ml (rv:80-590ng/ml), BSAP: 76UI/l (rv:31-95UI/L)] and a left femur magnetic resonance imaging (MRI) which revealed a diaphyseal fracture from stress. Prescription: 20µg daily of subcutaneous teriparatide (recombinant human PTH1-34; Forteo; Eli Lilly&Co., IN). After a 10-day treatment, the patient expressed a significant pain reduction, no longer requiring any device to walk. In 3 months, a CT scan showed the healed fracture, thus the patient could return to her usual activities. Conclusion: Atypical fracture healing associated to a long-term alendronate use was accelerated by 20µg daily subcutaneous teriparatide, leading to a fast recovery of her mobility and quality of life.
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