Rapid resolution with teriparatide in delayed healing of atypical fracture associated to long-term bisphosphonate use

MASTAGLIA SILVINA ; AGUILAR GABRIEL ; OLIVERI BEATRIZ

Roma

Congreso; European Congress on Osteoporosis and Osteoarthritis; 2013

International Osteoporosis Foundation

Bisphosphonates (BF) are the most widely used drugs to treat osteoporosis. 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 cases1Teriparatide is an anabolic drug which has shown to be effective in stimulating bone formation. Purpose: Description of the evolution of a right femoral diaphyseal fracture developed in a patient while taking a long term BF treatment. Case Report: A 57-yr-old postmenopausal Caucasian female, with a delayed healing of her right femoral diaphyseal fracture, after 10 months, despite 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 maternal fragility fracture.. 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 interrupted. 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 fracture from stress. Prescription: 20µg daily of subcutaneous teriparatide (recombinant human PTH1-34). 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 fracture had healed, thus the patient could return to her usual activities. Conclusion: Atypical fracture healing associated to a long-term alendronate use, accelerated by 20µg daily subcutaneous teriparatide, leading to a fast recovery of her mobility and quality of life. 1 J Bone Miner Res. 2010; 25:1-28.