Denosumab and metatarsal fracture healing: potential benefits with delayed remodeling: a case report

Denosumab is known to enhance callus formation while delaying remodeling. However, its effects on fracture healing are scarcely reported in the literature. This case report, to the best of our knowledge, is the first to report the potential effect of denosumab on a metatarsal fracture in an older adult patient, 4 months after administration, resulting in a favorable clinical course with early weight-bearing 17 days after the fracture.

A 73-year-old female sustained a right-foot second metatarsal fracture due to the fall of a heavy object. She has a history of diabetes mellitus, hypertension, and osteoporosis. Prior to sustaining the fracture, she received seven doses of denosumab spaced 6 months apart, with the last dose administered 4 months earlier. Furthermore, the patient was treated with a backsplint for 6 weeks. After 17 days, follow-up radiographs showed a large callus formation, with no pain and the ability to bear weight. Subsequent radiographs revealed a large callus with delayed remodeling.

This case report suggests that denosumab remains effective for promoting rapid callus formation even 4 months after administration for osteoporosis, despite delayed remodeling. This delay did not seem to have negative effects on the clinical outcomes, as the patient achieved weight-bearing within 17 days after sustaining the fracture.

Denosumab may positively influence fracture healing in older adults with metatarsal fractures, potentially leading to delayed remodeling. However, further studies are needed to confirm these observations.