Keywords
femoral fractures
denosumab
drug-related side effects and adverse
case report
osteoporosis
How to Cite
Abstract
Introduction: Denosumab reduces the osteoporotic fracture risks. Concerns regarding the rare side effects of antiresorptive therapies, such as atypical femur fracture, have contributed to the underuse of osteoporosis drugs.
Objective: To present a clinical case to recognize clinical characteristics, diagnosis, and management of an atypical femoral fracture due to the use of denosumab.
Case presentation: An 83-year-old female patient with osteoporosis at high fracture risk under management with zoledronic acid for five years with worsening bone mineral density, implementing denosumab, with three doses, presenting an atypical femoral fracture.
Discussion and conclusion: The efficacy of denosumab in reducing the risk of fractures in patients with a high risk of fractures is evident. There is significant uncertainty about how to treat patients after they have suffered an atypical femur fracture. Antiresorptive therapy's benefit in managing osteoporosis is greater than the risk of presenting an adverse event derived from antiresorptive therapy. Medical management with anabolic therapy is an alternative to osteoporosis treatment in this group of patients.
References
Kendler DL, Kendler DL, Cosman F, Stad RK, Ferrari S. Denosumab in the Treatment of Osteoporosis: 10 Years Later: A Narrative Review. Adv Ther. 2022 jan.;39:58-74. https://doi.org/10.1007/s12325-021-01936-y
Bone HG, Wagman RB, Brandi ML, Brown JP, Chapurlat R, Cummings SR, et. al. 10 years of denosumab treatment in postmenopausal women with osteoporosis: results from the phase 3 randomised FREEDOM trial and open-label extension. Lancet Diabetes Endocrinol. 2017 jul.;5(7):513-523. https://doi.org/10.1016/S2213-8587(17)30138-9
Ural A. Biomechanical mechanisms of atypical femoral fracture. J Mech Behav Biomed Mater. 2021 dec.;124: 104803. https://doi.org/10.1016/j.jmbbm.2021.104803
Lo JC, Hui RL, Grimsrud CD, Chandra M, Neugebauer RS, Gonzalez JR, et. al. The association of race/ethnicity and risk of atypical femur fracture among older women receiving oral bisphosphonate therapy. Bone. 2016 apr.;85:142–147. https://doi.org/10.1016/j.bone.2016.01.002
Marcano A, Taormina D, Egol KA, Peck V, Tejwani NC. Are race and sex associated with the occurrence of atypical femoral fractures? Clinical Orthopaedics and Related Research. 2014 mar.;472(3):1020–1027. https://doi.org/10.1007/s11999-013-3352-5
Starr J, Tay YKD, Shane E. Current Understanding of Epidemiology, Pathophysiology, and Management of Atypical Femur Fractures. Curr Osteoporos Rep. 2018;16:519-529. https://doi.org/10.1007/s11914-018-0464-6
Shane E, Burr D, Abrahamsen B, Alder RA, Brwon TD, Cheung AM, et. al. Atypical subtrochanteric and diaphyseal femoral fractures: Second report of a task force of the American society for bone and mineral research. Journal of Bone and Mineral Research. 2014 jan.;29(1):1-23. https://doi.org/10.1002/jbmr.1998
Cheung AM, McKenna MJ, van de Laarschot DM, Zillikens MC, Peck V, Srighanthan J, et. al. Detection of Atypical Femur Fractures. Journal of Clinical Densitometry. 2019 otc.-dec.;22(4):506-516. https://doi.org/10.1016/j.jocd.2019.07.003
Khan AA, Leslie WD, Lentle B, Iles S, Kaiser SM, Frame H, et. al. Atypical femoral fractures: A teaching perspective. Canadian Association of Radiologists Journal. 2015;66(2):102-107. https://doi.org/10.1016/j.carj.2014.01.002
Van de Laarschot DM, McKenna MJ, Abrahamsen B, Langdhl B, Cohen-Solal M, Guñabens N, et. al. Medical management of patients after atypical femur fractures: A systematic review and recommendations from the European Calcified Tissue society. Journal of Clinical Endocrinology and Metabolism. 2020 may.;105(5):1682-1699. https://doi.org/10.1210/clinem/dgz295
Ishizu H, Arita K, Terkawi MA, Shimizu T, Iwasaki N. Risks vs. benefits of switching therapy in patients with postmenopausal osteoporosis. Expert Rev Endocrinol Metab. 2021 jul. 26;16(5):217-228. https://doi.org/10.1080/17446651.2021.1956902
Noble JA, McKenna MJ, Crowley RK. Should denosumab treatment for osteoporosis be continued indefinitely? Ther Adv Endocrinol Metab. 2021;12. https://doi.org/10.1177/20420188211010052
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Copyright (c) 2023 Revista Colombiana de Endocrinología, Diabetes & Metabolismo