Bilateral fractures of femoral neck in patients with moderate renal failure receiving fluoride for spinal osteoporosis.

Abstract

Case reportsTwo patients with moderate renal failure sustained spontaneous bilateral hip fractures during treatment with fluoride, calcium, and vitamin D for osteoporosis. They had been taking sodium fluoride (40-60 mg/day) for 11 and 21 months, respectively. Histological examination of a specimen of the bone showed severe fluorosis in the first case, and quantitative analysis of bone showed osteomalacia and skeletal fluorosis in the other case. These abnormalities were considered to be the consequence of excessive retention of fluoride due to renal insufficiency.As bilateral femoral neck fractures are very rare these data suggest a causal link between fractures and fluoride in patients with renal failure. Thus fluoride should be given at a lower dosage, if at all, to patients with even mild renal failure. Introduction Fluoride, combined with calcium and vitamin D is effective in preventing new vertebral crush fractures not only in primary' but also in corticosteroid induced osteoporosis.2 Fractures of long bones have been described, however, during fluoride treatment, and 13 cases of fracture of the femoral neck, none of them bilateral, have been reported; the cause and effect relation has not been clearly established.4 6 We report on two patients with osteoporosis in whom bilateral hip fractures occurred spontaneously after 11 and 21 months of treatment with fluoride; the two patients suffered from moderate chronic renal insufficiency.

Importance of Preclinical Studies in the Development of Drugs for Treatment of Osteoporosis: A Review Related to the 1998 WHO Guidelines

“…Furthermore, animal studies carried out several years after a clinical report in fluoride-treated patients with chronic renal failure was published [67] 'confirmed' that impaired renal function markedly reduced bone tolerance to fluoride, with the occurrence of osteomalacia and decreased bone strength [68].…”

Bilateral trochanteric fractures of the femur in a patient with chronic renal failure

“…caused by osteoporosis [3,5] or seizures [6][7][8]. In patients with chronic renal failure both osteoporosis and uraemic seizure are seen [2,6].…”

Supraacetabular and Femoral Head Stress Fracture during Fluoride Treatment

“…To our knowledge they have not been described in steroid-induced osteoporosis treated with fluoride. Similarly, although femoral neck fractures have been reported [4,9,10,12,18], trabecular fatigue fractures in the femoral head have never been noted during fluoride therapy. In our case, the groin pain was related to an unusual supraacetabular fracture, followed by same sided femoral head trabecular fractures.…”

“…Fluoride with vitamin D and calcium supplementation is recommended by some patients with long-term steroid treatment [2,3], Some cases of bone fluorosis have, nev ertheless, been described [1,6,9,16]. It is possible that some steroid-treated patients have an increased sensitivity to fluoride [ …”