A new contralateral atypical femoral fracture despite sequential therapy with teriparatide and strontium ranelate

Hanh H Nguyen; Frances Milat; Peter R Ebeling

doi:10.1016/j.bonr.2017.01.002

A new contralateral atypical femoral fracture despite sequential therapy with teriparatide and strontium ranelate

Bone Rep. 2017 Jan 7:6:34-37. doi: 10.1016/j.bonr.2017.01.002. eCollection 2017 Jun.

Authors

Hanh H Nguyen¹, Frances Milat², Peter R Ebeling¹

Affiliations

¹ Department of Medicine, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia; Department of Endocrinology, Monash Health, Clayton, Victoria, Australia.
² Department of Medicine, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia; Department of Endocrinology, Monash Health, Clayton, Victoria, Australia; Hudson Institute of Medical Research, Clayton, Victoria, Australia.

Abstract

Atypical femoral fractures (AFFs) are a rare association of anti-resorptive therapy for osteoporosis. Limited evidence-based management guidelines on their optimal treatment exist, with observational studies suggesting a role for teriparatide (TPTD) in AFF healing. We report a case of a 65-year-old woman with postmenopausal osteoporosis who sustained an AFF following long-term bisphosphonate therapy, and who subsequently developed a new contralateral AFF after completion of TPTD therapy and initiation of strontium ranelate (SR) treatment. The sequence of events in this case report showed that TPTD and SR did not prevent the development of a new AFF, and questions the optimal treatment of these stress fractures.

Keywords: AFF, Atypical femoral fracture; Anabolic; Antiresorptive; Atypical femoral fracture; BMD, Bone mineral density; DXA, Dual energy X-ray absorptiometry; Osteoporosis; PTH, Parathyroid hormone; SR, Strontium ranelate; Strontium ranelate; TPTD, Teriparatide; Teriparatide.

Publication types

Case Reports