Sequential treatment with teriparatide and strontium ranelate in a postmenopausal woman with atypical femoral fractures after long-term bisphosphonate administration.
OBJECTIVE
Despite the existence of numerous case series, no evidenced-based medical management for atypical fractures associated with bisphosphonate (BP) treatment has been established.


METHODS
We report the outcome of teriparatide (TRP) administration followed by strontium ranelate (SR) in a woman with a complete and an incomplete contralateral atypical fracture of the femoral diaphysis (AFF) associated with BP treatment. The spontaneous complete AFF was managed with intramedullary nailing, discontinuation of BP and initiation TRP.


RESULTS
Eleven months later, she suffered a contralateral incomplete AFF. At the completion of the TRP treatment, she had only slight discomfort in the femur with the incomplete AFF. BMD testing revealed increase of 7.61% at the lumbar spine (LS) and 0.8% at the hip. Following TRP, 1-year SR treatment resulted in further BMD increase of 9.2% at the LS and 1.4% in the hip, while she does not report any pain. Bone markers remain within the normal range.


CONCLUSIONS
Our case indicates that sequential therapy with TRP and SR in cases of AFF might be a rational treatment option. However, there is a need for additional information concerning the effect of TRP and SR, given alone or sequentially, in these patients in order to incorporate these drugs into the management of AFF.
3rd Department of Orthopaedic Surgery, Laboratory for the Research of Musculoskeletal System "Th. Garofalidis", Medical School, University of Athens, General Hospital of Athens KAT, Athens, Greece.
Kalliopi
K
Lampropoulou-Adamidou
Laboratory for the Research of Musculoskeletal System "Th. Garofalidis", Medical School, University of Athens, General Hospital of Athens KAT, Athens, Greece.
Symeon
S
Tournis
Computed Tomography Department, General Hospital of Athens "Asklipion Voulas", Athens, Greece.
Alexia
A
Balanika
Laboratory for the Research of Musculoskeletal System "Th. Garofalidis", Medical School, University of Athens, General Hospital of Athens KAT, Athens, Greece.
Ioulia
I
Antoniou
3rd Department of Orthopaedic Surgery, Laboratory for the Research of Musculoskeletal System "Th. Garofalidis", Medical School, University of Athens, General Hospital of Athens KAT, Athens, Greece.
Ioannis P
IP
Stathopoulos
Radiology Imaging Department, General Hospital of Athens "G. Gennimatas", Athens, Greece.
Christos
C
Baltas
Laboratory for the Research of Musculoskeletal System "Th. Garofalidis", Medical School, University of Athens, General Hospital of Athens KAT, Athens, Greece.
Ioannis K
IK
Triantafillopoulos
Laboratory for the Research of Musculoskeletal System "Th. Garofalidis", Medical School, University of Athens, General Hospital of Athens KAT, Athens, Greece.
Nikolaos A
NA
Papaioannou
D000369:Aged, 80 and over; D050071:Bone Density Conservation Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D004164:Diphosphonates / Q000009:adverse effects* / Q000627:therapeutic use*; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D005264:Femoral Fractures / Q000139:chemically induced* / Q000601:surgery; D005594:Fracture Fixation, Intramedullary; D006801:Humans; D010024:Osteoporosis / Q000188:drug therapy*; D019379:Teriparatide / Q000008:administration & dosage / Q000627:therapeutic use*; D013876:Thiophenes / Q000008:administration & dosage / Q000627:therapeutic use*; D016896:Treatment Outcome; D028761:Withholding Treatment
D050071:Bone Density Conservation Agents; D004164:Diphosphonates; D013876:Thiophenes; C081587:strontium ranelate; D019379:Teriparatide