Pamidronic acid/zoledronic acid
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Bilateral femoral stress fractures: case report A 57-year-old woman with metastatic bony disease secondary to breast cancer developed spontaneous bilateral femoral stress fractures following treatment with pamidronic acid and then zoledronic acid [doses not stated]. In 1993 the woman was diagnosed with invasive breast cancer and underwent a mastectomy followed by adjuvant chemotherapy comprising fluorouracil, cyclophosphamide and methotrexate. Metastatic bony disease was detected in 2001 and treatment with monthly pamidronic acid [route not stated] and tamoxifen was started. The latter was discontinued 1 year later and anastrozole was started. Around this time, IV zoledronic acid became available and was substituted for pamidronic acid. Over the following few years she experienced compression fractures of her spine and a rib fracture. In early 2008 she reported bilateral hip pain. At this point she had been receiving monthly IV bisphosphonate therapy for nearly 6 years, apart from a brief period of zoledronic acid administered in alternate months. Bilaterally, new increased activity was noted in the lateral cortical areas of the proximal femurs on nuclear scintigraphy conducted in February 2008. Exemestane was started for suspected progressive disease. Her hip and thigh pain worsened despite titration of her analgesic regimen and radiotherapy did not provide relief. A spinal MRI in September 2008 revealed subacute vertebral compression at L1 with no evidence of metastatic disease. These findings were suggestive of osteoporosis. The following month, she was admitted for pain control and an MRI revealed incomplete transverse fractures of her left and right proximal femurs. The woman underwent surgical fixation with intramedullary rodding of both femurs, leading to prompt and marked pain relief. Pathological examination of the bone reamings found no evidence of metastatic disease. Bone biopsy showed fragments of lamellar bone with smooth layers of bone matrix, along with an area of jagged haphazard arrangement of osteocytes and bone matrix. In December 2008, the frequency of zoledronic acid administration was amended to every 3 months and later to every 6 months. The woman had stable disease and further surgery or radiotherapy was not required. Loke C, et al. Association of spontaneous bilateral femoral stress fractures with zoledronic acid use in a patient with metastatic breast cancer-a cautionary tale. 803057417 Community Oncology 8: 137-140, No. 3, Mar 2011 - USA
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Reactions 16 Jul 2011 No. 1360
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