Atypical femoral fracture in a patient treated with denosumab

Abstract

Atypical fractures of the femur (AFF) have been reported in the literature at an increasing rate over the past decade, especially in patients who have been on prolonged courses of bisphosphonates. However, there have only been a few reported cases of AFF in those treated with other antiresorptive medications. In this case report, a 72-year-old woman with chronic obstructive pulmonary disease and osteoporosis presented with an atraumatic right femoral fracture in the setting of denosumab use. In contrast with other reports, this patient had received bisphosphonate therapy for a short duration before the switch to denosumab. While causality between the fracture and denosumab use cannot be established in this case, there is a growing number of reports of a similar association. Ongoing vigilance is required to determine whether denosumab is associated with or potentially a cause of AFF.

Research on the Role of Matrix Metalloproteinase in the Patients with Stable Phase COPD Accompanied by Osteoporosis

“…Both BMI and age are the factors definitely associated with the patients' quality of life [24]. Our research result indicates that the CAT score in the COPD osteoporosis group are higher than that in the group of decreased COPD bone mineral density and the group of normal COPD bone mineral density.…”

Tibial stress reaction presenting as bilateral shin pain in a man taking denosumab for giant cell tumor of the bone

“…It has been postulated that besides atypical femoral fractures, bisphosphonates may contribute to the development of atypical fractures in other weight bearing long bones as well [23]. There have been 6 cases of atypical femoral fractures in patients taking denosumab previously reported (2 cases reported as part of the FREEDOM study extension) [6][7][8][9][10][11]. These cases are summarized in Table 1.…”

“…Whether denosumab is associated with atypical fractures remains unclear, however there are six reported cases of atypical femoral fractures occurring in patients taking denosumab Table 1 Previously reported cases of atypical femoral fractures [6][7][8][9][10][11]. for osteoporosis [6][7][8][9][10][11]. We report an interesting case of bilateral shin pain due to bilateral tibial stress reactions in an overweight 60-year-old man with no history of osteoporosis who was treated with prolonged high-dose denosumab as part of a clinical trial for management of an unresectable giant cell tumor of bone.…”

“…These non-traumatic fractures occurred in skeletal areas rich in cortical bone (in contrast to osteoporotic fractures which affect skeletal areas with high trabecular to cortical bone ratio, including the spine, hip, and radius). The occurrence of atypical femoral fractures in patients on denosumab has been reported as well (6 cases previously reported in the literature-summarized in Table 1) [6][7][8][9][10][11]. However the association is less well defined than the association of AFF with alendronate use [1].…”

Fracture healing: a consensus report from the International Osteoporosis Foundation Fracture Working Group

“…Atypical femoral fractures have been associated with greater duration of bisphosphonate therapy [58] and denosumab therapy [59]. Causality is undetermined, and up to 15 % of fractures occur without exposure to osteoporosis medications [58,60].…”