Effect of Long-Term Use of Bisphosphonates on Forearm Bone: Atypical Ulna Fractures in Elderly Woman with Osteoporosis

Abstract

Osteoporosis is a common musculoskeletal disease of the elderly population characterized by decreased bone mineral density and subsequent fractures. Bisphosphonates are a widely accepted drug therapy which act through inhibition of bone resorption and prevent fractures. However, in long-term use, atypical bisphosphonate induced fractures may occur, particularly involving the lower weight bearing extremity. Atypical ulna fracture associated with long-term bisphosphonate use is rarely reported in current literature. We present a 62-year-old woman with atypical ulna due to long-term alendronate therapy without a history of trauma or fall. Clinicians should be aware of stress fracture in a patient who has complaints of upper extremity pain and history of long-term bisphosphonate therapy.

Treatment strategy for atypical ulnar fracture due to severely suppressed bone turnover caused by long-term bisphosphonate therapy: a case report and literature review

“…Atypical fractures of the upper extremities are rare [6]. On literature search in April 2020, we could identify only 18 reports describing 25 atypical fractures of the ulna in the English and Japanese literature (11 and 7 reports, respectively) (Additional file 1) [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22]. In this case report, we describe the diagnosis and successful treatment of a patient with atypical fracture of the ulna.…”

Treatment of Atypical Fracture of the Ulnar Diaphysis by Open Reduction and Internal Fixation with Teriparatide

“…One report has described that a transverse configuration, localized periosteal, or endosteal thickening at the fracture site and generalized cortical thickening of the diaphysis are features of atypical ulnar fractures [15]. Some authors have postulated that the mechanism is related to SSBT because of pathological findings [7], whereas others have speculated that the mechanism is related to cyclical weight-bearing during ambulation while walking with a cane or frame [6, 9, 10, 13]. The injured forearm of our patient had some features of atypical fractures on radiography images, she had been under long-term bisphosphonate therapy, and she habitually used a hoe during agricultural work.…”

“…In contrast, the management of rare atypical fractures of the upper extremities has not been established. Four patients have been treated conservatively [4, 6, 10, 13], and four others had fractures fixed with a plate and a bone graft [5, 7, 12]. Four of five fractures treated by internal rigid fixation [3, 8, 9, 11] united uneventfully, and complications developed in one patient during the healing process.…”

Suppression of Bone Resorption by miR-141 in Aged Rhesus Monkeys

“…Thus, several types of drugs have been applied to inhibit OCs and treat OP: selective estrogen receptor modulators, bisphosphonates, and receptor activator of nuclear factor kappa‐B (RANK) ligand antibody drugs . However, because the limited treatment efficacy and adverse side effects, the available drugs are still not fully ideal for OP treatment . Thus, it is critical to develop new medications for the treatment of OP with better curative outcomes, limited side effects, and increased safety .…”