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Efavirenz/emtricitabine/tenofovir-disoproxil-fumarate Traumatic intra-articular proximal humerus fracture and periprosthetic fracture secondary to osteoporosis: case report

A 56-year-old man developed traumatic intra-articular proximal humerus fracture and periprosthetic fracture secondary to osteoporosis during treatment with efavirenz/emtricitabine/tenofovir-disoproxil-fumarate for HIV infection [duration of treatment to reaction onsets not stated]. The man, who was diagnosed with HIV infection 6 years prior, had been receiving antiretroviral treatment with efavirenz/ emtricitabine/tenofovir-disoproxil-fumarate [Atripla] 1 tablet/day [dose and route not stated]. He developed an intra-articular proximal humerus fracture in June 2011, and was admitted. Consequently, he underwent endoprosthesis placement. Subsequent clinical and radiological exams showed satisfactory results in terms of functional recovery and osteointegration of the prosthesis. Fourteen months following surgery, he was admitted again due to shoulder pain. He reported the pain started while he was swimming. An X-ray revealed periprosthetic fracture. Re-fracture in the same bone was suggestive of a localised osteoporosis. Thereafter, he underwent a revision of the fracture with a long-stem cuff tear arthropathy (CTA) endoprosthesis and the use of a plate with screws and metallic cerclages. The fractures were attributed to osteoporosis (excessive decrease of bone mineral density) secondary to efavirenz/emtricitabine/tenofovir-disoproxil-fumarate. The man’s treatment was switched to another drug which do not have tenofovir as its active ingredient. Subsequently, he was prescribed alendronic acid [alendronate] and colecalciferol for further prevention of osteoporosis. At a 84 month follow-up, he remained satisfied with his functional activity. Physical examination showed a forward flexion of 80°, external rotation of 30° and internal rotation of 60°. He was clinically evaluated on the following scales with the sores as follows: quick disabilities of the arm, shoulder and hand (DASH) 4,8, visual analog test (VAS) 2, simple shoulder test 66,7, University of California at Los Angeles (UCLA) score 24, the Amercian shoulder and elbow surgeons (ASES) 81, 6 and constant score 42. On subsequent X-ray, no periprosthetic bone density decrease was noted. De Carli A, et al. Bone methabolic disorders in HIV positive patients: a case report. Acta Bio-Medica : Atenei Parmensis 91: No. 3, 7 Sep 2020. Available from: URL: https:// 803507017 www.mattioli1885journals.com/index.php/actabiomedica/article/view/9026/9169

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Reactions 17 Oct 2020 No. 1826