Chronic kidney disease presenting with bilateral spontaneous femoral neck fracture: A case report

Abstract

Bone and mineral metabolism disorders are common in patients with chronic kidney disease (CKD). These patients are susceptible to fractures. Bilateral femoral neck fracture secondary to renal osteodystrophy is a rare complication. We report a case of CKD with bilateral spontaneous femoral neck fracture associated with secondary hyperparathyroidism and osteoporosis.

Keywords

• chronic kidney disease,bone and mineral disorders,secondary hyperparathyroidism,osteoporosis,fracture

References

1. Alem AM, Sherrard DJ, Gillen DL, Weiss NS, Beresford SA, Heckbert SR, Wong C, Stehman-Breen C. Increased risk of hip fracture among patients with end-stage renal disease. Kidney Int. 2000 Jul;58(1):396-9.
2. Kazama JJ. Chronic kidney disease and fragility fracture. Clin Exp Nephrol. 2017 Mar;21(Suppl 1):46-52. doi: 10.1007/s10157-016-1368-3.
3. Sidibé A, Auguste D, Desbiens LC, Fortier C, Wang YP, Jean S, Moore L, Mac-Way F. Fracture Risk in Dialysis and Kidney Transplanted Patients: A Systematic Review. JBMR Plus. 2018 Jul 5;3(1):45-55. doi: 10.1002/jbm4.10067.
4. Kwon YE, Choi HY, Kim S, Ryu DR, Oh HJ; ESRD Registry Committee of the Korean Society of Nephrology. Fracture risk in chronic kidney disease: A Korean population-based cohort study. Kidney Res Clin Pract. 2019 Jun 30;38(2):220-8. doi: 10.23876/j.krcp.18.0099.
5. Runesson B, Trevisan M, Iseri K, Qureshi AR, Lindholm B, Barany P, Elinder CG, Carrero JJ. Fractures and their sequelae in non-dialysis-dependent chronic kidney disease: the Stockholm CREAtinine measurements project. Nephrol Dial Transplant. 2019 Jul 30. pii: gfz142. doi: 10.1093/ndt/gfz142.
6. Torres PAU, Cohen-Solal M. Evaluation of fracture risk in chronic kidney disease. J Nephrol. 2017 Oct;30(5):653-61. doi: 10.1007/s40620-017-0398-6.
7. Tentori F, McCullough K, Kilpatrick RD, Bradbury BD, Robinson BM, Kerr PG, Pisoni RL. High rates of death and hospitalization follow bone fracture among hemodialysis patients. Kidney Int. 2014 Jan;85(1):166-73. doi: 10.1038/ki.2013.279.
8. Hardy P, Benoit J, Donneaud B, Jehanno P, Lortat-Jacob A. [Pathological fractures of the femoral neck in hemodialyzed patients. Apropos of 26 cases]. Rev Chir Orthop Reparatrice Appar Mot. 1994;80(8):702-10.

9. Jadoul M, Albert JM, Akiba T, Akizawa T, Arab L, Bragg-Gresham JL, Mason N, Prutz KG, Young EW, Pisoni RL. Incidence and risk factors for hip or other bone fractures among hemodialysis patients in the Dialysis Outcomes and Practice Patterns Study. Kidney Int. 2006 Oct;70(7):1358-66.
10. Ureten K, Oztürk MA, Ozbek M, Unverdi S. Spontaneous and simultaneous rupture of both Achilles tendons and pathological fracture of the femur neck in a patient receiving long-term hemodialysis. Int Urol Nephrol. 2008;40(4):1103-6. doi: 10.1007/s11255-008-9421-0.
11. Schaab PC, Murphy G, Tzamaloukas AH, Hays MB, Merlin TL, Eisenberg B, Avasthi PS, Worrell RV. Femoral neck fractures in patients receiving long-term dialysis. Clin Orthop Relat Res. 1990 Nov;(260):224-31. Zingraff J, Drueke T, Roux JP, Rondon-Nucete M, Man NK, Jungers P. Bilateral fracture of the femoral neck complicating uremic bone disease prior to chronic hemodialysis. Clin Nephrol. 1974;2(2):73-5.
12. Gerster JC, Charhon SA, Jaeger P, Boivin G, Briancon D, Rostan A, Baud CA, Meunier PJ. Bilateral fractures of femoral neck in patients with moderate renal failure receiving fluoride for spinal osteoporosis. Br Med J (Clin Res Ed). 1983 Sep 10;287(6394):723-5.
13. Undar L, Topcu S, Perçin S. Simultaneous bilateral fractures of the femoral neck and superior pubis ramus following renal failure-induced hypocalcaemic convulsions. Br J Clin Pract. 1990 Dec;44(12):774-6.
14. Kapukaya A, Aslan H, Necmioğlu S, Kandiya E. Kronik böbrek yetmezliği zemininde bilateral spontan femur boynu kırığı: vaka takdimi. Journal of Turgut Ozal Medical Center 1997;4(2):197-9.
15. Ogun TC, Memik R, Yel M, Sarlak A. Bilateral pathologic femoral neck fracture as a consequence of renal osteodystrophy: Report of two cases and review of the literature. J Arthroplasty Arthroscopy Surg 2001;12(2):199-202.
16. Hung KH, Lee CT, Gau YL, Chen JB. Neglected bilateral femoral neck fractures in a patient with end-stage renal disease before chronic dialysis. Ren Fail. 2001 Nov;23(6):827-31.
17. Karapinar H, Ozdemir M, Akyol S, Ulkü O. Spontaneous bilateral femoral neck fractures in a young adult with chronic renal failure. Acta Orthop Belg. 2003;69(1):82-5.
18. Devkota P, Ahmad S. Bilateral impacted femoral neck fracture in a renal disease patient. Niger Med J. 2013 Sep;54(5):354-5. doi: 10.4103/0300-1652.122374.
19. Garcia FL, Dalio RB, Sugo AT, Picado CHF. Bilateral spontaneous fracturing of the femoral neck in a patient with renal osteodystrophy. Rev Bras Ortop. 2014;49(5):540-2.
20. Sathyanarayana V, Patel MT, Raghavan S, Naresh D. Simultaneous Bilateral Femur Neck Fracture in A Young Adult with Chronic Renal Failure- A Case Report and Review of Literature. J Orthop Case Rep. 2015 Oct-Dec;5(4):24-6. doi: 10.13107/jocr.2250-0685.337.
21. Sarıkaya B, Kültür T. Nadir görülen iki taraflı kalça ağrısı nedeni: bilateral spontan proksimal femur kırığı. Kahramanmaraş Sütçü İmam Üniversitesi Tıp Fakültesi Dergisi (KSÜ Tıp Fak Der) 2015;10(1):11-13.
22. John R, Kumar P, Aggarwal S, Rajnish RK, Agarwal S, Vatsyan K. Simultaneous, Non-traumatic, Bilateral Neck Femur Fractures in Uremic Renal Osteodystrophy: A Report of Three Cases and Literature Review. J Orthop Case Rep. 2018 Mar-Apr;8(2):90-4. doi: 10.13107/jocr.2250-0685.1066.
23. Gerakis A, Hadjidakis D, Kokkinakis E, Apostolou T, Raptis S, Billis A. Correlation of bone mineral density with the histological findings of renal osteodystrophy in patients on hemodialysis. J Nephrol. 2000 Nov-Dec;13(6):437-43.
24. Jamal SA, Hayden JA, Beyene J. Low bone mineral density and fractures in long-term hemodialysis patients: a meta-analysis. Am J Kidney Dis. 2007 May;49(5):674-81.
25. Prasad B, Ferguson T, Tangri N, Ng CY, Nickolas TL. Association of Bone Mineral Density With Fractures Across the Spectrum of Chronic Kidney Disease: The Regina CKD-MBD Study. Can J Kidney Health Dis. 2019 Aug 20;6:2054358119870539. doi: 10.1177/2054358119870539.
26. Jamal SA, Swan VJ, Brown JP, Hanley DA, Prior JC, Papaioannou A, Langsetmo L, Josse RG; Canadian Multicentre Osteoporosis Study Research Group. Kidney function and rate of bone loss at the hip and spine: the Canadian Multicentre Osteoporosis Study. Am J Kidney Dis. 2010 Feb;55(2):291-9. doi: 10.1053/j.ajkd.2009.10.049.
27. Ramanath SK, Shah RH, Pradyumna YK. Ayurvedic Medications as Accelerating Cause of Atraumatic Bilateral Femur Neck Fracture in a Young Indian Male with Kidney Disease: A Unique Case Report. J Orthop Case Rep. 2019 Jan-Feb;9(1):45-8. doi: 10.13107/jocr.2250-0685.1302.
28. Mittalhenkle A, Gillen DL, Stehman-Breen CO. Increased risk of mortality associated with hip fracture in the dialysis population. Am J Kidney Dis. 2004 Oct;44(4):672-9.
29. Kaneko TM, Foley RN, Gilbertson DT, Collins AJ. Clinical epidemiology of long-bone fractures in patients receiving hemodialysis. Clin Orthop Relat Res. 2007 Apr;457:188-93.
30. Park JC, Kovesdy CP, Duong U, Streja E, Rambod M, Nissenson AR, Sprague SM, Kalantar-Zadeh K. Association of serum alkaline phosphatase and bone mineral density in maintenance hemodialysis patients. Hemodial Int. 2010 Apr;14(2):182-92. doi: 10.1111/j.1542-4758.2009.00430.x.
31. Maruyama Y, Taniguchi M, Kazama JJ, Yokoyama K, Hosoya T, Yokoo T, Shigematsu T, Iseki K, Tsubakihara Y. A higher serum alkaline phosphatase is associated with the incidence of hip fracture and mortality among patients receiving hemodialysis in Japan. Nephrol Dial Transplant. 2014 Aug;29(8):1532-8. doi: 10.1093/ndt/gfu055.