Fractures in Corticosteroid- and Bisphosphonate-treated Subjects With Longstanding Rheumatoid Arthritis

Abstract

Background: Bisphosphonates are the most widely prescribed agents for the treatment of postmenopausal osteoporosis and other metabolic bone diseases. Atypical femoral fractures in bisphosphonate-treated patients have raised concerns regarding the long-term safety of this class of medications.
 Case Presentation: In this study, we report two patients suffering from fractures while receiving biphosphonates; a postmenopausal patient with rheumatoid arthritis and a history of long-term use of bisphosphonates and glucocorticoids presenting with multiple fractures as case one and another 52-year-old female patient diagnosed with Systemic Lupus Erythematosus (SLE) who suffered from a femoral shaft fracture without any history of prior traumatic incidents as case two.
 Conclusions: Considering the low risk for atypical femoral fractures, further careful screening for these types of fractures should be undertaken. In addition, in order to lower the rate of fractures in patients on long-term bisphosphonate therapy, assessment of patients’ contralateral side should be considered to prevent further fractures, especially in patients with prodromal pain.