Atypical femoral fracture in a multiple myeloma patient undergoing treatment with denosumab: A case report and literature review.
Atypical femoral fracture
Denosumab
Multiple myeloma
Journal
International journal of surgery case reports
ISSN: 2210-2612
Titre abrégé: Int J Surg Case Rep
Pays: Netherlands
ID NLM: 101529872
Informations de publication
Date de publication:
Jul 2023
Jul 2023
Historique:
received:
18
05
2023
revised:
16
06
2023
accepted:
27
06
2023
medline:
9
7
2023
pubmed:
9
7
2023
entrez:
8
7
2023
Statut:
ppublish
Résumé
Denosumab is a new standard treatment for bone disease caused by multiple myeloma. There are a few reports of atypical femoral fracture in patients with multiple myeloma, all of which were associated with long-term use of bisphosphonate. Here, we report the first case of denosumab-induced atypical femoral fracture in a patient with multiple myeloma. A 71-year-old woman with multiple myeloma developed dull pain in her right thigh 8 months after restarting high-dose denosumab following its initial administration for 4 months and subsequent withdrawal for 2 years. Fourteen months later, complete atypical femoral fracture occurred. Osteosynthesis was achieved using an intramedullary nail and she was switched to oral bisphosphonate 7 months after cessation of denosumab. There was no exacerbation of the multiple myeloma. Bone union was achieved and she recovered to her pre-injury level of activities. The oncological outcome was alive with disease at 2 years after surgery. Prodromal symptoms such as thigh pain and radiographical finding of thickening of the lateral cortex in the subtrochanteric region of the femur were attributed to denosumab-induced atypical femoral fracture in the case. A unique aspect of this case worth highlighting is that the fracture occurred after short-term denosumab use. This may be associated with multiple myeloma or other medication including dexamethasone and cyclophosphamide. Atypical femoral fracture may occur in patients with multiple myeloma who receive denosumab, even for a short period. Attending physicians should be cognizant of the early symptoms and signs of this fracture.
Identifiants
pubmed: 37421768
pii: S2210-2612(23)00585-0
doi: 10.1016/j.ijscr.2023.108456
pmc: PMC10382856
pii:
doi:
Types de publication
Case Reports
Langues
eng
Pagination
108456Informations de copyright
Copyright © 2023 The Author(s). Published by Elsevier Ltd.. All rights reserved.
Déclaration de conflit d'intérêts
Declaration of competing interest The authors declare that they have no competing interests.
Références
N Engl J Med. 2020 Aug 20;383(8):743-753
pubmed: 32813950
Lancet Oncol. 2021 Mar;22(3):e119-e130
pubmed: 33545067
Ann Oncol. 2009 Aug;20(8):1303-17
pubmed: 19465418
J Bone Joint Surg Am. 2011 Jul 6;93(13):1235-42
pubmed: 21776577
Nat Rev Dis Primers. 2017 Jul 20;3:17046
pubmed: 28726797
J Oral Maxillofac Surg. 2009 Mar;67(3):645-9
pubmed: 19231794
Case Rep Orthop. 2014;2014:452418
pubmed: 25140264
Clin Orthop Relat Res. 2012 Mar;470(3):759-65
pubmed: 22125247
J Bone Miner Res. 2014 Jan;29(1):1-23
pubmed: 23712442
N Engl J Med. 2016 Oct 20;375(16):1532-1543
pubmed: 27641143
PLoS One. 2022 Feb 25;17(2):e0263839
pubmed: 35213543
Bone. 2012 Sep;51(3):524-7
pubmed: 22634175
HSS J. 2008 Sep;4(2):123-7
pubmed: 18815855
Oncologist. 2017 Apr;22(4):438-444
pubmed: 28275116
Lancet Diabetes Endocrinol. 2017 Jul;5(7):513-523
pubmed: 28546097
Lancet Oncol. 2018 Mar;19(3):370-381
pubmed: 29429912
Cureus. 2020 Aug 18;12(8):e9837
pubmed: 32953344
Osteoporos Int. 2010 Apr;21(4):705-8
pubmed: 19669853
Bone. 2013 Sep;56(1):199-203
pubmed: 23774445
Exp Ther Med. 2019 Sep;18(3):1571-1580
pubmed: 31410111
BMC Cancer. 2019 Oct 22;19(1):980
pubmed: 31640606
Int J Surg. 2020 Dec;84:226-230
pubmed: 33181358
J Musculoskelet Neuronal Interact. 2018 Sep 1;18(3):375-381
pubmed: 30179215
Blood. 2019 Apr 4;133(14):1534-1539
pubmed: 30760454