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Jeong, Na, Cho, Kim, and Park: An Atypical Subtrochanteric Femoral Fracture in a Patient with Multiple Myeloma Received Zoledronic Acid: A Case Report
Case Report
The Journal of the Korean Bone and Joint Tumor Society

The Journal of the Korean Bone and Joint Tumor Society 2012; 18(2): 99-103.

Published online: 27 December 2012

DOI: https://doi.org/10.5292/jkbjts.2012.18.2.99

An Atypical Subtrochanteric Femoral Fracture in a Patient with Multiple Myeloma Received Zoledronic Acid: A Case Report

Won-Ju Jeong, Sang-Bong Na, Hwan-Seong Cho*, Joon-Woo Kim, Il-Hyung Park

Department of Orthopedic Surgery, Kyungpook National University Hospital, Korea.

*Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Korea.

Correspondence to: Il-Hyung Park. Department of Orthopedic Surgery, Kyungpook National University Hospital, 130, Dongdeok-ro, Jung-gu, Daegu 700-721, Korea. TEL: +82-53-420-5634, FAX: +82-53-420-6337, ihparkmdrip@gmail.com

Received 4 October 2012       Revised 20 November 2012       Accepted 22 November 2012

Copyright © 2012 by The Korean Bone and Joint Tumor Society

(open-access):

"This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited."

Abstract

Little literature exists about the risk of atypical femoral fracture in patients received zoledronic acid for prevention of skeletal metastasis. We report an atypical subtrochanteric femoral fracture in a patient with multiple myeloma received zoledronic acid. The patient was treated by closed reduction and internal fixation with cephalomedullary nailing.

Keywords: atypical femoral fracture, multiple myeloma, zoledronic acid

Figures and Tables

Figure 1
(A) An atypical subtrochanteric femoral fracture was shown on simple radiograph. Note the cortical thickening of the proximal diaphysis of the femur. (B) There was no definite metastatic lesion but edematous infiltration and soft tissue swelling around the fracture site on T2 weighted image. (C) There was no definite tracer uptake on whole body bone scan except the fracture site. (D) There were no tumor cells on histologic examination. Note the hemorrhagic necrosis with inflammatory granulation tissue (H&E stain, ×100). (E) Closed reduction and internal fixation with a cephalomedullary nail was performed.
jkbjts-18-99-g001

References

1. Wardley A, Davidson N, Barrett-Lee P, et al. Zoledronic acid significantly improves pain scores and quality of life in breast cancer patients with bone metastases: a randomised, crossover study of community vs hospital bisphosphonate administration. Br J Cancer. 2005. 92:1869–1876.
2. Odvina CV, Zerwekh JE, Rao DS, Maalouf N, Gottschalk FA, Pak CY. Severely suppressed bone turnover: a potential complication of alendronate therapy. J Clin Endocrinol Metab. 2005. 90:1294–1301.
3. Body JJ, Bartl R, Burckhardt P, et al. Current use of bisphosphonates in oncology. International Bone and Cancer Study Group. J Clin Oncol. 1998. 16:3890–3899.
4. Rosen LS, Gordon D, Tchekmedyian NS, et al. Long-term efficacy and safety of zoledronic acid in the treatment of skeletal metastases in patients with nonsmall cell lung carcinoma and other solid tumors: a randomized, Phase III, double-blind, placebo-controlled trial. Cancer. 2004. 100:2613–2621.
5. Pazianas M, Cooper C, Ebetino FH, Russell RG. Long-term treatment with bisphosphonates and their safety in postmenopausal osteoporosis. Ther Clin Risk Manag. 2010. 6:325–343.
6. Kwek EB, Goh SK, Koh JS, Png MA, Howe TS. An emerging pattern of subtrochanteric stress fractures: a long-term complication of alendronate therapy? Injury. 2008. 39:224–231.
7. Mashiba T, Hirano T, Turner CH, Forwood MR, Johnston CC, Burr DB. Suppressed bone turnover by bisphosphonates increases microdamage accumulation and reduces some biomechanical properties in dog rib. J Bone Miner Res. 2000. 15:613–620.
8. Kyle RA, Yee GC, Somerfield MR, et al. American Society of Clinical Oncology. American Society of Clinical Oncology 2007 clinical practice guideline update on the role of bisphosphonates in multiple myeloma. J Clin Oncol. 2007. 25:2464–2472.
9. Van Poznak CH, Temin S, Yee GC, et al. American Society of Clinical Oncology. American Society of Clinical Oncology executive summary of the clinical practice guideline update on the role of bone-modifying agents in metastatic breast cancer. J Clin Oncol. 2011. 29:1221–1227.
10. Puhaindran ME, Farooki A, Steensma MR, Hameed M, Healey JH, Boland PJ. Atypical subtrochanteric femoral fractures in patients with skeletal malignant involvement treated with intravenous bisphosphonates. J Bone Joint Surg Am. 2011. 93:1235–1242.
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