Atypical fracture of the tibial diaphysis associated with bisphosphonate therapy: A case report

Bissonnette, Lyne; April, Pierre-Marc; Dumais, Réjean; Boire, Gilles; Roux, Sophie

doi:10.1016/j.bone.2013.07.012

Cited by 30 publications

(21 citation statements)

References 26 publications

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“…Again, this case fulfills all the major criteria except for the location. The Authors discussed the need for greater awareness of the possibility of atypical fractures at other sites than the femur, especially in weight-bearing bones (18). Likewise we suggest that one should be aware that also fractures on the medial side of the femur may be considered atypical fractures associated with bisphosphonate use.…”

Section: The Relationship Between Vitamin D Receptor (Vdr) Polymorphimentioning

confidence: 99%

“…Insufficiency fractures related to bisphosphonate-induced suppression of bone turnover have also been reported at sites other A B @ C I C E d i z i o n i I n t e r n a z i o n a l i than the femoral diaphysis, including the pelvis, ankle, metatarsals and long bones such as the humerus, fibula and tibia (17,18). Recently, was described a case of a patient on long-term bisphosphonate therapy who presented with a diaphyseal tibial insufficiency fracture.…”

Section: The Relationship Between Vitamin D Receptor (Vdr) Polymorphimentioning

confidence: 99%

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�Atypical� atypical femur fractures and use of bisphosphonates

Laarschot

Somford

Jager

et al. 2016

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SummaryBackground. Atypical femur fractures (AFFs) present a rare but serious condition associated with use of bisphosphonates. Underlying mechanisms and clinical risk factors remain unclear. According to the diagnostic criteria formulated by the ASBMR, a lateral localization of an AFF is required. Case history. We present a patient who developed bilateral leg pain while using an oral bisphosphonate and aromatase inhibitor in the course of adjuvant treatment for breast cancer. Initially she was diagnosed with bone metastases and received radiotherapy on the right femur. However, the bilateral periosteal reactions of the subtrochanteric femur are highly suggestive of AFFs. Our case meets all criteria for AFF except that she presented with lesions at the medial side of the femur. Therefore they could be best described as "atypical" atypical femur fractures. Discussion. Since the pathogenesis of AFFs is not fully understood, we cannot rule out that AFFs also occur in the medial femur or in other weight-baring bones. Hence we propose that medial stress reactions belong to a spectrum of atypical fractures associated with use of antiresorptive drugs. The localization may depend on yet unknown biomechanical factors.

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Section: The Relationship Between Vitamin D Receptor (Vdr) Polymorphimentioning

confidence: 99%

Section: The Relationship Between Vitamin D Receptor (Vdr) Polymorphimentioning

confidence: 99%

�Atypical� atypical femur fractures and use of bisphosphonates

Laarschot

Somford

Jager

et al. 2016

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“…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].…”

Section: Discussionmentioning

confidence: 94%

“…Atypical tibial fractures have been reported in patients receiving long term treatment with bisphosphonates [19,22,23]. 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].…”

Section: Discussionmentioning

confidence: 99%

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

Lim

Rastalsky

Choy

et al. 2015

Bone

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“…A possible long-term effect of bisphosphonate use is a stress fracture of the proximal femur progressing into a complete atypical femoral fracture (AFF) (1)(2)(3)(4)(5)(6)(7). The mechanism involved in the development of these atypical femur fractures remains unclear, and the bone pathology at the fracture site has not yet well been established (8).…”

Section: Introductionmentioning

confidence: 99%

Histological and micro Computed Tomography analysis of a femoral stress fracture associated with prolonged bisphosphonate use

Somford

Kloen

et al. 2017

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SummaryBackground. The origin of atypical femoral fractures (AFF) associated with bisphosphonate therapy remains to be elucidated. In this study, a biopsy of an AFF site is analyzed to determine whether microdamage and/or morphological changes are present in the area of the AFF. Material and methods. Cortical bone from an AFF region was obtained during a preventive stabilization in a patient with a symptomatic AFF. This bone was scanned using microCT (resolution=0.01 mm), stained with basic fuchsin and analyzed histologically. Results. The diameter of the Haversian canals was higher in the vicinity of the AFF compared to the bone further away from the AFF. The bone mineral density within the cortex ranged from 1020 to 1080 mg HA/cm 3 . We observed penetration of basic fuchsin into the matrix, which is a tell-tale sign of diffuse damage. Discussion. The higher diameter of haversian canals is likely to result in higher local stresses and consequently increased microdamage. The diffuse microdamage in the biopsy may furthermore be directly related to bisphosphonate use, preventing repair of microdamage, and consequently the development of the AFF. Conclusion. Increased porosity of the cortex and accumulation of microdamage might have lead to a stress fracture and ultimately a complete AFF.

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Atypical fracture of the tibial diaphysis associated with bisphosphonate therapy: A case report

Cited by 30 publications

References 26 publications

�Atypical� atypical femur fractures and use of bisphosphonates

�Atypical� atypical femur fractures and use of bisphosphonates

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

Histological and micro Computed Tomography analysis of a femoral stress fracture associated with prolonged bisphosphonate use

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