title: A new contralateral atypical femoral fracture despite sequential therapy with teriparatide and strontium ranelate.
abstract: Atypical femoral fractures (AFFs) are a rare association of anti-resorptive therapy for osteoporosis. Limited evidence-based management guidelines on their optimal treatment exist, with observational studies suggesting a role for teriparatide (TPTD) in AFF healing. We report a case of a 65-year-old woman with postmenopausal osteoporosis who sustained an AFF following long-term bisphosphonate therapy, and who subsequently developed a new contralateral AFF after completion of TPTD therapy and initiation of strontium ranelate (SR) treatment. The sequence of events in this case report showed that TPTD and SR did not prevent the development of a new AFF, and questions the optimal treatment of these stress fractures.
authors.affiliation: Department of Medicine, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia; Department of Endocrinology, Monash Health, Clayton, Victoria, Australia.
authors.forename: Hanh H
authors.initials: HH
authors.lastname: Nguyen
authors.affiliation: Department of Medicine, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia; Department of Endocrinology, Monash Health, Clayton, Victoria, Australia; Hudson Institute of Medical Research, Clayton, Victoria, Australia.
authors.forename: Frances
authors.initials: F
authors.lastname: Milat
authors.affiliation: Department of Medicine, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia; Department of Endocrinology, Monash Health, Clayton, Victoria, Australia.
authors.forename: Peter R
authors.initials: PR
authors.lastname: Ebeling
keywords: AFF, Atypical femoral fracture; Anabolic; Antiresorptive; Atypical femoral fracture; BMD, Bone mineral density; DXA, Dual energy X-ray absorptiometry; Osteoporosis; PTH, Parathyroid hormone; SR, Strontium ranelate; Strontium ranelate; TPTD, Teriparatide; Teriparatide