PDF(Pubmed)
Abstract：
The benefits of denosumab as an antiresorptive therapy and in reducing fragility fractures are well documented. However, its association with atypical femur fractures (AFFs), especially in the absence of prior bisphosphonate use, remains poorly understood and warrants further investigation. This case report presents a rare instance of bilateral AFFs in a 78-year-old bisphosphonate-naïve patient with a history of long-term denosumab therapy for previous metastatic breast cancer. Management involved intramedullary nail fixation after initial presentation with a unilateral AFF and a recommendation to cease denosumab therapy. However, the patient subsequently experienced a contralateral periprosthetic AFF below a total hip implant 5 months thereafter and was treated with open reduction internal fixation. This case report highlights the critical need for orthopedic surgeons to maintain a high level of suspicion and vigilance in screening for impending AFFs, especially in patients with a prolonged history of denosumab therapy without prior bisphosphonate use. Furthermore, the growing report of such cases emphasizes the urgent need for comprehensive research aimed at refining treatment protocols that balance the therapeutic benefits of denosumab and its associated risks of AFFs.
摘要：
denosumab作为抗吸收疗法和减少脆性骨折的益处已得到充分证明。然而,其与非典型股骨骨折（AFF）的关系，特别是在没有预先使用双膦酸盐的情况下，仍然知之甚少，需要进一步调查。该病例报告介绍了一名78岁的双膦酸盐初治患者中罕见的双侧AFF病例，该患者有长期的denosumab治疗既往转移性乳腺癌的病史。管理涉及在初次使用单侧AFF后进行髓内钉固定，并建议停止denosumab治疗。然而,随后5个月后,患者在全髋关节植入物下方经历了对侧假体周围AFF,并接受了切开复位内固定治疗.本病例报告强调了骨科医生在筛查即将发生的AFF时保持高度怀疑和警惕的迫切需要。特别是在长期使用地诺塞马布治疗而没有使用双膦酸盐的患者中。此外，越来越多的此类病例报告强调,迫切需要进行全面研究,以完善治疗方案,平衡denosumab的治疗益处及其相关AFF风险.
