A case of stress fracture: What is the underlying cause?

Öz

Stress fractures are encountered commonly in clinical practice. Many features of stress fractures are in common, but the differences depend on the condition of the underlying bone. The clinician should approach according to the type of stress fracture. We report a 71-year-old female patient with osteoporosis, who had been taking prolonged bisphosphonate therapy and a single dose denosumab, sustained bilateral atypical femoral fractures (AFF) eight months apart.

Anahtar Kelimeler

• stress fracture,atypical femoral fracture,bisphosphonate,denosumab

Bir stres kırığı olgusu: Altta yatan neden nedir?

Öz

Stres kırıklarına klinik pratikte sıkça rastlanılmaktadır. Stres kırıklarının birçok özelliği ortaktır, ancak altta yatan kemiğin durumuna bağlı olarak farklılıklar vardır. Klinisyen stres kırığı tipine göre yaklaşımda bulunmalıdır. Bu makalede uzun süreli bifosfonat tedavisi ve tek doz denosumab alan, sekiz ay arayla bilateral atipik femoral kırığı gelişmiş 71 yaşında osteoporozlu bir kadın hastayı sunuyoruz.

Anahtar Kelimeler

• stres ftraktürü,atipik femur fraktürü,bisfosfonat,denosumab

Kaynakça

1. References 1.McKenna MJ, Heffernan E, Hurson C, McKiernan FE. Clinician approach to diagnosis of stress fractures including bisphosphonate-associated fractures. QJM 2014 Feb; 107(2): 99-105. 2.Shane E, Burr D, Abrahamsen B, et al. Atypical subtrochanteric and diaphyseal femoral fractures: second report of a task force of the American Society for Bone and Mineral Research. J Bone Miner Res 2014; 29(1): 1-23. 3. Butler I,Tipping B, Bhaga R. Atypical femoral fractures. JEMDSA 2013; 18(2): 125-127. 4. Dell R, Greene D, Ott SM, Silverman S, Eisemon E, Funahashi T, et al. A retrospective analysis of all atypical femur fractures seen in a large California HMO from the years 2007 to 2009. J Bone Miner Res. 2010; 25: 61. 5. Dell R, Greene D. A proposal for an atypical femur fracture treatment and prevention clinical practice guideline. Osteoporos Int. 2018 Jun;29(6):1277-1283 6. Silverman S, Kupperman E, Bukata S. Bisphosphonate-related atypical femoral fracture: Managing a rare but serious complication. Cleve Clin J Med 2018 Nov; 85(11): 885-893 7. Dell RM, Greene D, Tran D. Stopping bisphosphonate treatment decreases the risk of having a second atypical femoral fracture. Paper presented at: American Academy of Orthopaedic Surgeons (AAOS) Annual Meeting 2012 Feb 7-11; San Francisco, CA, USA. 8. Min BW, Koo KH, Park YS, Oh CW, Lim SJ, Kim JW, et al. Scoring System for Identifying Impending Complete Fractures in incomplete Atypical Femoral Fractures. J Clin Endocrinol Metab 2017; 102(2): 545-50.