title: Applying low-intensity pulsed ultrasounds (LIPUS) to a zoledronate-associated atypical femoral shaft fracture without cessation of zoledronate therapy for 3 years follow up: a case report.
abstract: Reports are increasing regarding atypical femoral fractures (AFFs) caused by minor trauma in patients using bisphosphonates (BPs) for long periods. Patients with malignant skeletal metastases potentially are at greater risk for these AFFs, especially considering the high dose and the duration of treatment with BPs. We evaluated a case of atypical femoral shaft fracture treated with an intramedullary nail in a patient treated for five years with zoledronate who had breast cancer with metastases to bone. Although bone union was achieved without cessation of zoledronate therapy by applying low-intensity pulsed ultrasounds (LIPUS), the remodeling phase of the fracture healing process was delayed. For BPs-associated AFFs, LIPUS is an alternative to parathyroid hormone (PTH) analogs such as teriparatide that are contraindicated in patients with malignant skeletal metastases. LIPUS is an effective treatment for fracture healing and may avoid the necessity to discontinue BP therapy.
authors.affiliation: Department of Orthopaedic Surgery, Jikei University School of Medicine, Tokyo, Japan.
authors.forename: Shoutaro
authors.initials: S
authors.lastname: Arakawa
authors.affiliation: Department of Orthopaedic Surgery, Jikei University School of Medicine, Tokyo, Japan.
authors.forename: Mitsuru
authors.initials: M
authors.lastname: Saito
authors.affiliation: Department of Orthopaedic Surgery, Jikei University School of Medicine, Tokyo, Japan.
authors.forename: Makoto
authors.initials: M
authors.lastname: Kubota
authors.affiliation: Department of Orthopaedic Surgery, Jikei University School of Medicine, Tokyo, Japan.
authors.forename: Hidehiko
authors.initials: H
authors.lastname: Suzuki
authors.affiliation: Department of Orthopaedic Surgery, Jikei University School of Medicine, Tokyo, Japan.
authors.forename: Shigeki
authors.initials: S
authors.lastname: Tsuchida
authors.affiliation: Department of Orthopaedic Surgery, Jikei University School of Medicine, Tokyo, Japan.
authors.forename: Kurando
authors.initials: K
authors.lastname: Hashimoto
authors.affiliation: Department of Orthopaedic Surgery, Jikei University School of Medicine, Tokyo, Japan.
authors.forename: Keishi
authors.initials: K
authors.lastname: Marumo
keywords: LIPUS; atypical femoral fracture; bisphosphonate; breast cancer; malignant skeletal metastasis; zoledronate
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