Tibial stress reaction presenting as bilateral shin pain in a man taking denosumab for giant cell tumor of the bone

Lim, Sian Yik; Rastalsky, Naina; Choy, Edwin; Bolster, Marcy B.

doi:10.1016/j.bone.2015.06.017

Cited by 6 publications

(4 citation statements)

References 25 publications

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“…We searched the PubMed database for papers related to atypical tibia fractures and discovered 97 references. After checking all of the titles and abstracts, we found three reports of atypical tibia fractures related to denosumab use [ 8 – 10 ]. The results are shown in Table 1 .…”

Section: Case Presentationmentioning

confidence: 99%

“… Author (Year) Age (years) Sex Diagnosis Antiresorptive agent (duration) Fracture site Management Sian et al. [ 8 ] (2015) 60 M Giant cell tumor Denosumab (120 mg/month, 4 years) Bilateral tibial shaft Conservative treatment Schimpf et al. [ 9 ] (2018) 76 F Rheumatoid arthritis, glucocorticoid-induced osteoporosis Risedronate (5 years), Strontium ranelate (2 years), Zoledronate (4 years), Denosumab (60 mg/6-monthly, 2 years) Bilateral distal tibial metaphyseal fractures Plate fixations Intramedullary nail fixation Juan et al.…”

Section: Case Presentationmentioning

confidence: 99%

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Atypical tibial fracture in breast cancer patient with bone metastasis receiving denosumab therapy: a case report and review of the literature

et al. 2023

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Background Denosumab therapy is often used to reduce skeletal-related events in metastatic bone disease. On the other hand, there have been some instances of atypical femoral fracture in patients with metastatic bone disease treated with denosumab. In this case report, we describe a patient with metastatic bone disease due to breast cancer who had been using denosumab for 4 years to prevent skeletal-related events and suffered an atypical tibial fracture. Case presentation We report here the case of an 82-year-old Japanese woman who had received yearly intravenous denosumab for 4 years and presented with a fracture fulfilling the criteria for an atypical fracture, except for being located at the tibial diaphysis. She was found to have stage 4 breast cancer with multiple bone metastases 4 years prior. She had difficulty walking due to her tibial pain and underwent surgical treatment. Four months after surgery, the tibial fracture site exhibited bone fusion. Conclusion In patients with long-term use of denosumab to prevent skeletal-related events in metastatic bone disease, it is important to be aware of shin and thigh pain and to examine for signs of atypical tibial fractures to pay attention to atypical femoral fractures.

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Section: Case Presentationmentioning

confidence: 99%

Section: Case Presentationmentioning

confidence: 99%

Atypical tibial fracture in breast cancer patient with bone metastasis receiving denosumab therapy: a case report and review of the literature

et al. 2023

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“…The majority of atypical fractures seen in patients taking bone‐modifying agents are femoral, although atypical tibial fractures have also been reported . The American Society of Bone and Mineral Research (ASBMR) definition of atypical fractures includes only femoral sites, and defines them as atraumatic or low‐trauma fractures located in the subtrochanteric region or femoral shaft .…”

Section: Atypical Fracturesmentioning

confidence: 99%

“…Atypical fractures have been reported in individuals using antiresorptive therapy, mostly in women receiving long‐term bisphosphonate therapy for osteoporosis, but also in patients with malignant bone disease using bisphosphonates or denosumab, although they are extremely rare in this setting . There were no reported cases of atypical fractures in the pivotal phase III denosumab trials in patients with bone metastases .…”

Section: Atypical Fracturesmentioning

confidence: 99%

Denosumab: Prevention and management of hypocalcemia, osteonecrosis of the jaw and atypical fractures

Pittman

Antill

Goldrick

et al. 2016

Asia-Pac J Clin Oncol

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Denosumab, a bone-modifying agent, reduces the risk of skeletal-related events in patients with bone metastases from solid tumors and is generally well tolerated. However, hypocalcemia, osteonecrosis of the jaw (ONJ) and atypical fracture are potential and important toxicities of denosumab therapy that require attention. In pivotal phase III trials in patients with bone metastases from solid tumors, the incidence of hypocalcemia was 9.6% in denosumab-treated patients, with most events being asymptomatic, grade 2 and resolving by week 4. Established hypocalcaemia requires additional short-term calcium and vitamin D supplementation and, if severe, administration of intravenous calcium. ONJ was reported in 1.8% of patients receiving denosumab over 3 years in these trials. Involvement of an experienced oro-maxillary surgeon is important if ONJ is suspected. Atypical fractures were rare in a large study of denosumab using the dose and scheduling approved for the treatment of osteoporosis. To prevent toxicities, patients should maintain calcium and vitamin D supplementation, good oral hygiene and regular dental reviews throughout treatment. This article presents case studies from our clinical practice and discusses the pathophysiology of these toxicities along with guidance on prevention, diagnosis and management.

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Denosumab/methylprednisolone/pantoprazole

2016

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Tibial stress reaction presenting as bilateral shin pain in a man taking denosumab for giant cell tumor of the bone

Cited by 6 publications

References 25 publications

Atypical tibial fracture in breast cancer patient with bone metastasis receiving denosumab therapy: a case report and review of the literature

Atypical tibial fracture in breast cancer patient with bone metastasis receiving denosumab therapy: a case report and review of the literature

Denosumab: Prevention and management of hypocalcemia, osteonecrosis of the jaw and atypical fractures

Denosumab/methylprednisolone/pantoprazole

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