Successful Conservative Treatment of Multiple Atypical Fractures After Bisphosphonates Medication

초록

Introduction: Bisphosphonates have been widely validated and prescribed for the treatment of osteoporosis. At the same time, there have been case reports of atypical fractures citing their long-term use which inhibits the turnover of bone components. We recently experienced atypical fractures caused by bisphosphonates known as a prophylaxis for osteoporotic fractures. Case: A 64-year-old woman visited the outpatient clinic of the department of physical medicine and rehabilitation in September 2013 with pain in her right thigh and weakness of both legs. Without traumatic episodes had the patient a limping gait due to the pain in her right thigh which had begun 4 months before. And her symptoms had aggravated in recent 3 months. She had taken prophylactic ibandronic sodium (Bonviva inj) for osteoporosis since 2010, 3mg every three months, 13 times in total. Dual Energy X-ray Absorptiometry (DEXA) in February 2013 showed the decreased bone marrow density of the L-spine (T-score -3.4) and femur at total (T-score -1.6). We examined an electrodiagnostic study for the weakness of lower limbs, and there were no definite abnormal findings. At the same time, the images of the nuclear medicine and radiology scans and showed atypical fractures at the L4 pedicles, right subtrochanter of femur and left femur shaft (Figure1 and 2). We stopped bisphosphonates because we suspected that the atypical fractures of both the femur and spine were caused by the bisphosphonates.