Bisphosphonate-Associated Bilateral Atraumatic Ulna Fractures
Journal Title: International Journal of Medical and Pharmaceutical Case Reports - Year 2017, Vol 9, Issue 1
Abstract
Aims: From 2003, low-impact fractures have been reported in association with bisphosphonate (BP) therapy. Most have involved the proximal femur, but over 100 cases involving other anatomic locations have been published. The 2010 American Society for Bone and Mineral Research case definition for subtrochanteric or femoral shaft “atypical” fractures (AFF) included non-comminution, transverse orientation, cortical thickening, beaking, and minimal trauma. Because other anatomic locations were excluded, there has been an unstated assumption since then that these atypical fractures are limited to the femur. We present a case of bilateral fractures of the proximal shaft of ulna after bisphosphonate therapy. The similarity to the AFFs suggests that the anatomic location of atypical fractures is not limited to the femur. Methodology: Case report. Results and Discussion: After 15 years of BP use and several months of pain, the patient was diagnosed with a non-displaced transverse fracture of the left proximal ulnar diaphysis. Subsequently she developed a similar insufficiency fracture in her right ulna, and 2 months later the left fracture broke spontaneously. It was non-comminuted, transverse, with cortical thickening, and beaking. It was preceded by prodromal pain. This similarity to the AFFs suggests that the anatomic location of atypical fractures is not limited to the femur. Conclusions: Non-femoral atypical-type fractures have been associated with BP therapy. These atypical fractures suggest a systemic rather than local BP effect, and their exclusion has thus understated the incidence of BP-associated atypical fractures.
Authors and Affiliations
W. Banks Hinshaw, Jennifer P. Schneider
Keywords
Related Articles
- EP ID EP309440
- DOI 10.9734/IJMPCR/2017/33170
- Views 144
- Downloads 0
EBV-Positive Grey Zone Lymphoma in an HIV Infected Man from Kampala, Uganda: Case Report
Aim: We describe the clinical, histopathological and immunophenotypic characteristics of an HIV-infected adult man on antiretroviral therapy who presented with an EBV-positive grey zone lymphoma. Case Presentation: A 56-...
Impacted Urethral Stone in a Female: Case Report
Aims: To present a case of impacted urethral stone in a female. Presentation of Case: A 32-year-old female presented at the Family Medicine clinic with a history of external urethral meatal pain and a foreign body in her...
Torsades De Pointes Induced by Methadone and Clonazepam Use
Background: While recent data showed that illicit drug use rates at six months of treatment with either methadone or buprenorphine were comparable among patients [1] and that slow-release oral morphine was not inferior t...
Using Pazopanib and Radiotherapy to Treat Metastatic Renal Cell Carcinoma with Acrometastases
Introduction: Renal cell carcinoma (RCC) is the third most common urological cancer. Skeletal metastases from renal cell carcinoma are common, but metastatic tumors involving the hand and foot are rare. This is known as...
A Case of QT-interval Prolongation in the Context of High-dose, Intravenous Midazolam in a Methadone Maintained Patient
The following case illustrates a case of significant prolonged QT-interval (QTc) prolongation following intravenous administration of high-dose midazolam in a patient with severe hyperactive delirium. A prolonged QTc rep...