Atypical periprosthetic acetabular fracture in long-term alendronate therapy

Abstract

SummaryBisphosphonates have been commonly used in the treatment of osteoporosis, demonstrating its efficacy in fracture risk reduction. However, even if are generally safe and well tolerated, concerns have emerged about atypical fractures related to its prolonged use. Although atypical femoral fracture are more common, case reports demonstrated that even other skeletal areas can be involved by unusual pattern of fracture. We report a atypical acetabular periprosthetic fracture in a 83-year-old female patient after prolonged alendronate treatment for osteoporosis and isolated acetabular revision surgery. The patient underwent to clinical, bioumoral and radiological evaluation and all the history cases were fully reported. We believe this periprosthetic fracture, according to the available data, may have similar underlying pathology to atypical femoral fractures. Awareness of symptoms, in addition to a regular radiographic survey may facilitate early diagnosis and possible prevention of spontaneous periprosthetic fractures, in patients receiving bisphosphonate therapy beyond 5 years. The treatment of this atypical periprosthetic fracture should include both surgical than pharmacological therapy to obtained bone healing.

Conservative treatment of early-onset tubercular periprosthetic joint infection following total knee arthroplasty

“…Periprosthetic joint infections represent one of the most common complication following joint arthroplasty, both after primary or revision surgery [18][19][20][21]. However tubercular PJI is a rare clinical condition in developed countries.…”

A New Diagnostic Approach for Periprosthetic Acetabular Fractures Based on 3D Modeling: A Study Protocol

“…Classified as a spontaneous fragility fracture with substantial bone stock loss [18], the patient therefore underwent acetabular revision surgery without fracture fixation, as proposed by Simon et al [19]. This solution has been reported by other authors with good results in terms of fracture healing and functional results [30,31].…”

The Treatment of Acute Diaphyseal Long-bones Fractures with Orthobiologics and Pharmacological Interventions for Bone Healing Enhancement: A Systematic Review of Clinical Evidence

“…Results from experimental studies on ovariectomized rats suggested the tibia fractures treated with strontium ranelate heal faster, with abundant callus and with higher BMD. Regarding the clinical use of strontium ranelate for fracture healing, the evidence is limited to clinical cases that suggest a potential benefit in complicated long bones fractures, atypical fractures and periprosthetic femoral fractures [11,[88][89][90].…”

“…Pharmacological interventions that could modulate the healing process positively have been recently merged to the treatment algorithm, where systemic anti-osteoporosis drugs are considered the additional contributing factor [8]. The role of systemic drug therapies in long bones fracture healing remains limited, although the use several anabolic agents has reported positive results in selected shaft fractures types, such as atypical femoral fractures, periprosthetic femoral fractures and recalcitrant non-unions [9][10][11].…”