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Stress Fracture of the Femoral Shaft in Paget’s Disease of Bone: A Case Report

Sarthak Nepal|Atthakorn Jarusriwanna|Aasis Unnanuntana
대한골대사학회 (The Korean Society of Bone Metabolism)|2021.05|대한골대사학회지 (Journal of Bone Metabolism)|제28권 제2호|pp. 171-178

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키워드

stressFemurFracturesFracture healingOsteitis deformansPaget’s disease of bone
주제분류정형외과학

초록

Paget’s disease of bone (PDB) is a progressive bone disorder characterized by increased osteoclast-mediated bone resorption and abnormal bone formation. Incomplete atypical femoral fracture, appearing radiographically as a stress fracture at the lateral aspect of the femur, is an uncommon low-trauma fracture frequently seen in association with long-term bisphosphonate therapy. We describe the case of a 61-year-old female patient with PDB who developed a stress fracture at the lateral femoral cortex after 5 doses of intravenous bisphosphonate. The conservative treatment plan included discontinuation of bisphosphonate, a continuation of calcium and vitamin D supplementation, and limited weight-bearing for 3 months. The patient’s pain level gradually improved after switching to the new treatment plan. At the latest follow-up, approximately 5 years after the initiation of conservative treatment, the patient remained pain-free, and her PDB was well-controlled. However, the fracture line was still visible on the most recent radiograph. Although it remains unclear whether a stress fracture at the lateral femoral cortex occurred due to bisphosphonate therapy or PDB, this case highlights the importance of careful evaluation of any lesion that appears in PDB patients receiving bisphosphonate therapy.

Abstract

Paget’s disease of bone (PDB) is a progressive bone disorder characterized by increased osteoclast-mediated bone resorption and abnormal bone formation. Incomplete atypical femoral fracture, appearing radiographically as a stress fracture at the lateral aspect of the femur, is an uncommon low-trauma fracture frequently seen in association with long-term bisphosphonate therapy. We describe the case of a 61-year-old female patient with PDB who developed a stress fracture at the lateral femoral cortex after 5 doses of intravenous bisphosphonate. The conservative treatment plan included discontinuation of bisphosphonate, a continuation of calcium and vitamin D supplementation, and limited weight-bearing for 3 months. The patient’s pain level gradually improved after switching to the new treatment plan. At the latest follow-up, approximately 5 years after the initiation of conservative treatment, the patient remained pain-free, and her PDB was well-controlled. However, the fracture line was still visible on the most recent radiograph. Although it remains unclear whether a stress fracture at the lateral femoral cortex occurred due to bisphosphonate therapy or PDB, this case highlights the importance of careful evaluation of any lesion that appears in PDB patients receiving bisphosphonate therapy.

참고문헌 (35)

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A Case Report of Long-Term Bisphosphonate Therapy and Atypical Stress Fracture of Bilateral Femur고영진, 김혜원, 문석호, 조일련대한재활의학회 · Annals of Rehabilitation Medicine2013 · 제37권 제3호Atypical femoral neck fracture after prolonged bisphosphonate therapy김광균, 김태형, 박영욱, 서경덕대한병리학회 · Journal of Pathology and Translational Medicine2020 · 제54권 제4호Paget 병에서 발생한 발견하지 못한 불완전 스트레스 골절 - 1예 보고 -김홍균, 노규철, 박용욱, 박진수, 유정한, 정국진, 조민영, 황지효대한고관절학회 · Hip and Pelvis2011 · 제23권 제1호Pathogenesis, Management and Prevention of Atypical Femoral Fractures임건일, 정승효대한골대사학회 · 대한골대사학회지2015 · 제22권 제1호Paget’s Disease of Bone Affecting Peripheral Limb: Difficulties in Diagnosis: A Case Report강윤경, 왕배위, 홍수민, Jun-Ku Lee대한골대사학회 · 대한골대사학회지2020 · 제27권 제1호Is It a Simple Stress Fracture or Bisphosphonate-related Atypical Fracture?강번중, 강수용, 김민규, 백지훈, 이한준대한골대사학회 · 대한골대사학회지2012 · 제19권 제2호

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