Denosumab-Associated Peri-Implant Atypical Femur Fracture: A Case Report

Area of Science:

• Orthopedic surgery
• Pharmacology
• Bone metabolism

Background:

• Bisphosphonates are commonly prescribed to treat osteoporosis and other bone diseases.
• Long-term bisphosphonate use is linked to adverse skeletal effects, including atypical fractures.
• Atypical femur fractures are characterized by specific radiographic and clinical features.

Observation:

• The patient had a history of bisphosphonate use.
• The patient experienced a bisphosphonate-associated atypical femur fracture.
• A subsequent atypical femur fracture occurred around a reconstruction nail used to treat the initial fracture.

Findings:

• This case illustrates a rare complication of bisphosphonate therapy: recurrent atypical femur fracture at a surgical site.
• The biomechanical stress from the reconstruction nail may have contributed to the peri-implant fracture.
• Slowed bone turnover, a known effect of bisphosphonates, could impair healing and increase fracture risk.

Implications:

• Clinicians should maintain a high index of suspicion for atypical fractures in patients on bisphosphonates, even after surgical intervention.
• Further research is needed to understand the optimal management of bisphosphonate-associated fractures, particularly those occurring around implants.
• This case underscores the importance of considering medication history in the evaluation of complex fractures.