SİBEL BAŞARAN, İLKE COŞKUN BENLİDAYI, Burçak AKIN, RENGİN GÜZEL

Uzun Süreli Bifosfonat Kullanımına Bağlı Olarak Gelişen Bilateral İnkomplet Atipik Femur Fraktürü: Bir Olgu Sunumu

Bifosfonatların (BP) güvenlik profili genel olarak iyi olmakla birlikte son zamanlarda uzun süreli kullanımları ile ilişkilendirilebilen yan etkiler gündeme gelmeye başlamıştır. Bu olgu raporunda uzun süre BP kullanımına bağlı olarak gelişen bilateral inkomplet atipik femur fraktürü (AFF) olgusu sunulmuştur. Yirmi yıldır cerrahi menapozda olup, 10 yıl kadar önce vertebra kırığı sonrasında BP tedavisi başlanan 69 yaşındaki hasta, 6 ay önce başlayan ve 2 haftadır artış gösteren uyluk ağrısı nedeniyle başvurdu. Fizik muayenesinde antaljik yürüyüşü mevcuttu. Torakal kifozu artmıştı. Künt perküsyonla torakolomber vertebral hassasiyeti mevcuttu. Direkt grafilerinde her iki femurda subtrokanterik bölgede lateral kortekste kalınlaşma ve solda kortekste radyolusen görünüm tespit edildi. Vertebra grafilerinde ise L3 ve L4 vertebralarda yükseklik kaybı mevcuttu. Serum 25-hidroksi vitamin D [25(OH)D], parathormon, alkalen fosfataz ve kalsiyum düzeyleri ile osteoporoz markerları normal sınırlardaydı. AFF olarak değerlendirilen hastanın BP tedavisi kesilerek kalsiyum ve vitamin D takviyesine devam edildi. Ağrısı çok şiddetli olmadığından 3 ay süre ile konservatif tedavi (sınırlı yük verme, baston kullanımı) önerildi. Teriparatid tedavisi başlanarak önerilerle taburcu edildi. Uzun süredir BP tedavisi altında olan ve uyluk ağrısı ile başvuran hastalarda nadir görülen bir durum olan AFF akılda tutulmalı ve komplet kırık aşamasından önce gerekli yaklaşımlarda bulunulmalıdır.

Bilateral Incomplete Atypical Femoral Fracture due to Long-Term Bisphosphonate Use: A Case Report

Although the overall safety profile of bisphosphonates (BP) is favorable, adverse effects associated with long-term use have came up during recent years. In this report, a case of bilateral incomplete atypical femoral fracture (AFF) due to prolonged BP use was presented. A 69-year-old patient, who has been in surgical menopause for 20 years and was started on BP following vertebral fracture almost 10 years ago, was admitted with thigh pain, which was increased two weeks ago. On physical examination, she had antalgic gait, increased thoracic kyphosis and tenderness to percussion over the thoracolumbar region. Lateral cortical thickness in the subtrochanteric region of both femurs and cortical radiolucency on the left femur were observed on plain radiography. Loss of height in L3 and L4 vertebrae was detected on vertebral radiography. Serum 25-hydroxy vitamin D [25(OH)D], parathyroid hormone, alkaline phosphatase and calcium levels, along with osteoporosis markers were all within the normal ranges. As the patient was diagnosed with AFF, BP therapy was terminated and vitamin D-calcium supplementation was continued. Since she did not have severe pain, conservative management (limited weight bearing, using a walking stick) was recommended for 3 months. Teriparatide therapy was started and she was discharged with recommendations. AFF, which is a rare disorder, should be kept in mind in patients on long-term BP treatment who are admitted with thigh pain and, necessary interventions should be tailored before the occurrence of complete fracture.

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