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Atypical femur fractures and fracture nonunion: case report A woman in her 70’s [age at onset not stated] developed atypical femur fractures and fracture non-union due to long term treatment with alendronic acid followed by zoledronic acid for osteoporosis. The woman was diagnosed with osteoporosis at the age of 71 years. In June 2007, osteoporosis was complicated to osteoporotic fractures and she started receiving antiosteoporosis treatment with alendronic-acid 70 mg/week [alendronate; route not stated] along with calcitriol and calcium carbonate. She presented to a hospital in June 2012 with left hip pain, limiting mobility after a fall. X-ray examination showed a left femoral subtrochanteric transverse fracture. Based on her medical history and imaging characteristics, she was diagnosed with atypical femur fracture (AFF). By that time, she had been on alendronic-acid for 5 years. She underwent closed reduction and intra-medullary nailing for AFF. Her antiosteoporosis treatment was continued postoperatively. At the 2 months follow-up, examinations revealed unhealed fracture, unchanged position of the internal fixation of the left hip and well-aligned fracture ends. In March 2013, she was again hospitalised with T8 vertebral compression fracture after an accidental fall. At that time, she had taken alendronic-acid for 5 years 9 months. Thus, she received treatment with a single dose of IV zoledronic acid 5mg instead of alendronic-acid and she received another 5mg of zoledronic acid approximately 1 year later in April 2014. In April 2015 she presented to the hospital with pain in the left hip when walking. X-ray of the left hip showed fracture nonunion. The woman’s treatment with zoledronic acid was switched to teriparatide and she continued on calcitriol and calcium carbonate. In June 2015, she had right AFF and she underwent intramedullary nailing and her teriparatide treatment was continued. At 4 months postoperatively X-ray showed fracture healing. In April 2018, she had aggravated left hip pain when walking and she underwent replacement of the full-length intramedullary nail, new spiral blade was inserted and finally the fracture ends were cleaned. At 3 months postoperatively Xray showed fracture healing, good internal fixation and she had no pain or discomfort on weight bearing. Author comment: "Bisphosphonates (BPs) are first-line drugs for the treatment of osteoporotic fractures, but longterm use of BP reduces bone turnover and is associated with atypical femur fractures (AFFs). Additionally, BP treatment may cause delayed fracture healing or nonunion". Zhang H-Y, et al. Different surgical outcomes in a patient with bilateral atypical femoral fracture related to bisphosphonate use with or without teriparatide treatment. Osteoporosis International 30: 2349-2354, No. 11, Nov 2019. Available 803435166 from: URL: http://doi.org/10.1007/s00198-019-05131-2 - China

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Reactions 23 Nov 2019 No. 1780