Weekly Teriparatide for Delayed Unions of Atypical Subtrochanteric Femur Fractures

Abstract

IntroductionThe occurrence of atypical femur fractures (AFFs) in patients on prolonged bisphosphonate treatment has been gaining medical attention, but the use of pharmacotherapy for these fractures has not been explored in detail. The authors describe a case of AFFs successfully treated with once-weekly administration of 56.5 μg teriparatide (TPTD).Case PresentationThe patient was a 74-year-old female patient who had been taking alendronate for approximately 6 years and who suffered with a fall while walking. X-rays revealed a subtrochanteric right femur fracture. The contralateral femur showed cortical thickening and a transverse radiolucent fracture line. Based on these specific features, the patient was diagnosed with AFF. The patient underwent osteosynthesis with intramedullary nailing for the right fracture. Alendronate treatment was discontinued. Low-intensity pulsed ultrasonography therapy did not affect the healing of the fracture with delayed union, even after 3 months of application. Prophylactic osteosynthesis was performed for the subtrochanteric left femur. Bone tissue collected from the left fracture site during surgery showed severe suppression of bone turnover. Union of bilateral femurs was achieved after 3 months of a once-weekly administration of TPTD.ConclusionOnce-weekly TPTD treatment is shown to be beneficial for improving the healing of AFFs showing delayed union.Electronic supplementary materialThe online version of this article (doi:10.1007/s13554-014-0013-5) contains supplementary material, which is available to authorized users.

Effect of Teriparatide on Healing of Atypical Femoral Fractures: A Systemic Review

“…One patient was additionally treated with strontium ranelate because of persistent discomfort after 24 months of TPTD treatment. [ 25 26 27 28 29 30 31 ]…”

Atypical Femur Fractures in Patients Treated with Bisphosphonates: Identification, Management, and Prevention

“…Recent warnings about cardiovascular risk may preclude this, but short-term use may be helpful in some individuals, particularly in health economies where it may be difficult to get access to TPD. There is also one reported case in the literature of TPD being used on a weekly rather than daily basis and improving fracture healing, which may be more cost-effective 40. In addition one case has been reported of the use of low-intensity pulsed ultrasound, which may prove helpful in patients in whom TPD is contraindicated (e.g.…”

Teriparatide Treatment for An Atypical Fracture of the Femoral Shaft: A Case Report

“…Thus, the exact pathological process is unclear, and the treatment strategy for AFF is controversial. Also, cases of delayed union in patients treated with bisphosphonates have been reported [8][9][10] . However, by treating our patient with teriparatide, we achieved bone union much sooner than described in other reported cases of healed fractures 10,11 .…”