Long-term administration of bisphosphonates strongly suppresses osteoclastic bone
resorption and rarely causes atypical fractures. This report presents a case of bilateral
atypical ulnar fractures, following an 8-year course of zoledronate to treat breast
cancer bone metastasis. Nonsurgical treatment for the left ulnar fracture failed,
in spite of minimal displacement with callus formation at initial presentation. After
failure of plate fixation with a pedicled vascularized bone graft, removal of osteosclerotic
lesions and plate fixation with corticocancellous iliac bone graft resulted in bone
healing, although the healing process took 1.5 years. Plate fixation for the contralateral
fractured ulna was unsuccessful.
Key words
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Hand SurgeryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Incidence, risk factors, and fracture healing of atypical femoral fractures: a multicenter case-control study.Osteoporos Int. 2018; 29: 2427-2435
- Suppressed bone turnover by bisphosphonates increases microdamage accumulation and reduces some biomechanical properties in dog rib.J Bone Miner Res. 2000; 15: 613-620
- Atypical forearm fractures associated with long-term use of bisphosphonate.Arch Orthop Trauma Surg. 2013; 133: 889-892
- Dosing of zoledronic acid with its anti-tumor effects in breast cancer.J Bone Oncol. 2015; 4: 98-101
- The role of osteoclasts in breast cancer bone metastasis.J Bone Oncol. 2016; 5: 93-95
- Incidence of atypical femur fractures in cancer patients: the MD Anderson Cancer Center experience.J Bone Miner Res. 2016; 31: 1569-1576
- Ulnar fractures with bisphosphonate therapy: a systematic review of published case reports.Osteoporos Int. 2015; 26: 421-429
- Atypical fracture of the proximal shaft of the ulna associated with prolonged bisphosphonate therapy.Clin Orthop Surg. 2018; 10: 389-392
- Bisphosphonate-related atypical femoral fracture with bone metastasis of breast cancer: case report and review.Anticancer Res. 2014; 34: 1245-1249
- Simultaneous bilateral atypical femoral fracture in a patient receiving denosumab: case report and literature review.Osteoporos Int. 2016; 27: 827-832
- Atypical subtrochanteric and diaphyseal femoral fractures: second report of a task force of the American Society for Bone and Mineral Research.J Bone Miner Res. 2014; 29: 1-23
- Mechanical property and tissue mineral density differences among severely suppressed bone turnover (SSBT) patients, osteoporotic patients, and normal subjects.Bone. 2011; 49: 1279-1289
- Vascularized autograft healing.in: Wood M.B. Gilbert A. Microvascular Bone Reconstruction. Martin Dunitz Ltd., London1997: 37-39
Article info
Publication history
Published online: April 09, 2021
Accepted:
February 18,
2021
Received:
November 24,
2019
Footnotes
No benefits in any form have been received or will be received related directly or indirectly to the subject of this article.
Identification
Copyright
© 2022 by the American Society for Surgery of the Hand. All rights reserved.
