Teriparatide for Rapid Resolution of Delayed Healing of Atypical Fracture Associated with Long- Term Bisphosphonate Used

MASTAGLIA SR ; AGUILAR G ; OLIVERI B

European Journal Rheumatology

AVES

Año: 2015

Bisphosphonates (BFs) are the most widely used drugs to treat osteoporosis. However, recent reports associate long-term bisphosphonate use with atypical low-impact fractures and prodromal pain. It is estimated that 26% of cases of atypical fractures associated with the long-term use of BPs show delayed healing or nonunion. Teriparatide (PTH1-34) (TPD) is an anabolic drug which has shown to be effective in stimulating bone formation. The aim was to describe the course of a right diaphyseal femoral fracture sustained by a patient on long term BPs treatment. A 57-yr-old postmenopausal Caucasian female, presenting delayed healing of a right femoral diaphyseal fracture 10 months after fracture, despite orthopedic treatment. The fracture was preceded by progressive, severe, bilateral thigh pain. Her medical history included osteopenia treated with alendronate over 7 yrs. On presentation at our laboratory, the patient ambulated with the aid of a walking cane. Diagnosis was atypical right femoral fracture associated with long-term alendronate use. The following studies were performed: 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 stress fracture. Prescription: 20µg daily of subcutaneous teriparatide (s.c.TPD) (PTH1-34, Forteo; Eli Lilly&Co., Indianapolis, IN, USA). Computed tomography (CT) scan at 3 months showed the fracture had healed; the patient was able to resume her usual activities. Twenty micrograms of daily s.c.TPD accelerated healing of atypical fracture associated with long-term alendronate therapy, allowing fast recovery of ambulation and quality of life.