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Beware of bone pain with bisphosphonates
Venthan Jeyaratnam Mailoo1, Vidya Srinivas2, Jeremy Turner2
1Anaesthetics Department, Nottingham University Hospitals NHS Trust, Nottingham, UK.
BMJ Case Reports
|March 16, 2019
Summary
Long-term bisphosphonate use, like ibandronate, can lead to atypical femoral fractures (AFFs). Early detection and stopping therapy can prevent these serious fractures.
Area of Science:
- Endocrinology
- Orthopedics
- Pharmacology
Background:
- Bisphosphonates are commonly prescribed for osteoporosis and bone diseases.
- Long-term bisphosphonate therapy is associated with an increased risk of atypical femoral fractures (AFFs).
- Ibandronate is a nitrogen-containing bisphosphonate used in treating bone conditions.
Observation:
- A 71-year-old woman on ibandronate for 10 years reported persistent mid-thigh pain.
- Pelvic X-ray revealed bilateral femoral cortical expansion, a sign of impending AFFs.
Findings:
- The patient's symptoms and imaging indicated a high risk of AFFs due to prolonged ibandronate use.
- Stopping ibandronate therapy was crucial in averting fracture.
- Treatment with vitamin D and parathyroid hormone was initiated.
Implications:
- Regular monitoring and review of bisphosphonate therapy are essential for patients on long-term treatment.
- Vigilance for prodromal symptoms of AFFs can lead to early intervention.
- Preventing AFFs through careful medication management reduces patient morbidity and mortality.
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