1 Department of Endocrinology, Medical Center, Amager and Hvidovre Hospital, The Capital Region of Denmark2 Department of Cardiology, Nephrology and Endocrinology, Nordsjællands Hospital, The Capital Region of Denmark3 Kirurgisk Gastroenterologisk Klinik, Abdominal Centre, Rigshospitalet, The Capital Region of Denmark
OBJECTIVE: We report a case of a successfully healed atypical femoral fracture (AFF) following treatment with teriparatide in a patient with osteogenesis imperfecta (OI). To our knowledge no successful treatment of AFF's with teriparatide in this subpopulation has ever been described.METHODS: This is a case report of an AFF treated with teriparatide.RESULTS: The patient was treated with hormone replacement therapy for 18 years and bisphosphonates for nine years before suffering a spontaneous AFF in the form of a dislocated non-comminute transverse fracture of the right femoral shaft and an open reduction and internal fixation (ORIF) with a T2 Femoral Nail was done. Due to nonunion and another fracture distal to the nail she was re-operated with exchange ORIF and off label treatment with teriparatide 20 microgram/day was started. An x-ray one month later showed early signs of fracture healing. A subsequent x-ray 6 months after the last operation showed a solid healing of both right femoral fractures.CONCLUSION: This is a rare case that highly suggests a potential fracture healing effect of teriparatide treatment and highlights a potential significant practical therapeutic consideration in relation to the management of AFF with delayed healing.
Endocrine Practice : Official Journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists, 2014, Vol 20, Issue 10