장기간 Bisphosphonate계 약물 복용 후 발생한 비정형 대퇴 전자 하부 골절 및 골 생검
Bone Biopsy of Atypical Subtrochanteric Fracture in Patient with Prolonged Bisphosphonate Therapy - A Case Report -
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초록
비스포스포네이트계 약물은 장단기간의 안정성과 효능은 입증되었으나, 장기간 사용시 지속적인 골 교체 과정의 억제로인한 부전 골절을 일으킨다는 보고들이 있다. 알렌드로네이트를 12년간 꾸준히 복용하고 있는 68세 여자 환자가 수개월전부터 발생한 우측 대퇴부 통증으로 내원하여 전자 하부 부전 골절로 진단 후, 알렌드로네이트의 투여를 중지하고 외래추시 1개월 만에 대퇴골 전자 하부의 전이성 비정형 골절로 수술적 치료를 시행받았다. Tetracyclin을 사용한 조골세포 표지 골 생검을 시행받았으며, 검사 소견상 심각한 골다공증이 의심되는 소견이 관찰되었다. 본 증례는 골다공증 치료를 위하여 장기간 사용한 비스포스포네이트가 골밀도는 증가시킬 수 있지만, 과도한 골 교체의 저하를 유발하며, 정상적인 골재형성을 억제하여 골질을 저하시킴으로 오히려 골 강도를 떨어뜨리고, 비정형 골절을 조장할 수 있다는 소견을 골 생검을 통하여 추정할 수 있었다.
Abstract
Although alendronate was considered generally safe and effective to osteoporosis in short-long term studies, it remains the potential risk of severely suppressed bone turnover that causes insufficient fracture of femur. In this report, we describe a patient of atypical subtrochanteric fracture who treated with prolonged alendronate. A 68-years old woman who had a history of medication of alendronate for 12 years was presented to the outpatient clinic with right thigh pain. The radiographs revealed thickening and fracture line of the lateral side of subtrochanteric area of the right femur. She discontinued taking the medicine and follow up closely. After 1 month later, she sustained atypical subtrochanteric femoral fracture after simple fall, and underwent an internal fixation with compression hip screw. After operation,bone biopsy was done with tetracycline staining for valuation of bone metabolism and severe osteoporosis was observed. Although long-term use of bisphosphonate could increase bone mineral density, this case showed that it could lead insufficient fracture by decreasing bone strength through severely suppressed bone turnover, inhibition of normal bone formation and decreased bone quality. [Korean Journal of Bone Metabolism, 18(2): 131-135, 2011]
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