Article information
Resumen
La osteoporosis se define como una enfermedad que afecta el sistema músculoesquelético y se caracteriza por disminución en la masa mineral ósea con deterioro de la microarquitectura del tejido óseo que predispone a fracturas como principal complicación.
El alendronato es usado como terapia para el tratamiento de la osteoporosis. Uno de sus efectos adversos es la sobresupresión de los osteoclastos con el riesgo potencial de causar fracturas por estrés.
Se presenta un caso de una fractura femoral atraumática en una mujer de 42 años en terapia con alendronato durante seis años.
Palabras clave:
alendronato
osteoporosis
fractura espontánea
Summary
Osteoporosis is a disease that affects the skeleton and it is characterized by low bone mass and micro-structural deterioration of bone architecture, leading to an increased susceptibility to fracture as the main complication.
Alendronate is used as treatment for osteoporosis. One of the side-effects is the over-suppression of osteoclasts with the potential risk of stress fractures.
We present a case of atraumatic femoral fracture in a 42 year-old woman on alendronate therapy during six years.
Key words:
alendronate
osteoporosis
spontaneous fracture
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Referencias
[1.]
J.F. Molina, L.A. González.
Osteoporosis: enfoque clínico y de laboratorio.
Medicina & Laboratorio, 16 (2010), pp. 111-140
[2.]
M.J. Favus.
Bisphosphonates for Osteoporosis.
N Engl J Med, 363 (2010), pp. 2027-2035
[3.]
M. Sharpe, N. Stuart, C.M. Spencer.
Alendronate An Update of its Use in Osteoporosis.
Drugs, 61 (2001), pp. 999-1039
[4.]
R.G. Russell, M.J. Rogers.
Bisphosphonates: from the laboratory to the clinic and back again.
Bone, 25 (1999), pp. 97-106
[5.]
D.E. Hughes, K.R. Wright, H.L. Uy, A. Sasaki, T. Yoneda, G.D. Roodman, et al.
Bisphosphonates promote apoptosis in murine osteoclasts in vitro and in vivo.
J Bone Miner Res, 10 (1995), pp. 1478-1487
[6.]
C.V. Odvina, J.E. Zerwekh, D.S. Rao, N. Maalouf, F.A. Gottschalk, C.Y. Pak.
Severely suppressed bone turnover: a potential complication of alendronate therapy.
J Clin Endocrinol Metab, 90 (2005), pp. 1294-1301
[7.]
J. Schilcher, P. Aspenberg.
Incidence of stress fractures of the femoral shaft in women treated with bisphosphonate.
Acta Orthop, 80 (2009), pp. 413-415
[8.]
R.K. Cheung, K.K. Leung, K.C. Lee, T.C. Chow.
Sequential non- traumatic femoral shaft fractures in a patient on long-term alendronate.
Hong Kong Med J, 13 (2007), pp. 485-489
[9.]
J.P. Schneider.
Should bisphosphonates be continued indefinitely? An unusual fracture in a healthy woman on long-term alendronate.
Geriatrics, 61 (2006), pp. 31-33
[10.]
T. Ali, R.H. Jay.
Spontaneous femoral shaft fracture after long-term alendronate.
Age Aging, 38 (2009), pp. 625-626
[11.]
G.Y. Boivin, P.M. Chavassieux, A.C. Santora, J. Yates, P.J. Meunier.
Alendronate increases bone strength by increasing the mean degree of mineralization of bone tissue in osteoporotic women.
Bone, 27 (2000), pp. 687-694
[12.]
M.P. Somford, F.W. Draijer, B.J. Thomassen, P.M. Chavassieux, G. Boivin, S.E. Papapoulos.
Bilateral fractures of the femur diaphysis in a patient with rheumatoid arthritis on long-term treatment with alendronate: clues to the mechanism of increased bone fragility.
J Bone Miner Res, 24 (2009), pp. 1736-1740
[13.]
S.K. Goh, K.Y. Yang, J.S. Koh, M.K. Wong, S.Y. Chua, D.T. Chua, et al.
Subtrochanteric insufficiency fractures in patients on alendronate therapy: a caution.
J Bone Joint Surg Br, 89 (2007), pp. 349-353
[14.]
A.S. Neviaser, J.M. Lane, B.A. Lenart, F. Edobor-Osula, D.G. Lorich.
Low-energy femoral shaft fractures associated with alendronate use.
J Orthop Trauma, 22 (2008), pp. 346-350
[15.]
A. Guisti, N.A.T. Hamdy, S.E. Papapoulos.
Atypical fractures of the femur and bisphosphonate therapy: a systematic review of case/case series studies.
Bone, 24 (2010), pp. 1736-1740
[16.]
R.P. Tonino, P.J. Meunier, R. Emkey, J.A. Rodriguez-Portales, C.J. Menkes, Wasnich, Phase III Osteoporosis Treatment Study Group, et al.
Skeletal benefits of alendronate: 7-year treatment of postmenopausal osteoporotic women.
J Clin Endocrinol Metab, 85 (2000), pp. 3109-3115
[17.]
D.M. Black, D.E. Thompson, D.C. Bauer, K. Ensrud, T. Musliner, M.C. Hochberg, FIT Research Group, et al.
Fracture risk reduction with alendronate in women with osteoporosis: the Fracture Intervention Trial.
J Clin Endocrinol Metab, 85 (2000), pp. 4118-4124
[18.]
S.M. Ott.
Long-term safety of bisphosphonates.
J Clin Endocrinol Metab, 90 (2005), pp. 1897-1899
[19.]
D.M. Black, M.P. Kelly, H.K. Genant, L. Palermo, R. Eastell, C. Bucci-Rechtweg, et al.
Bisphosphonates and fractures of the subtrochanteric or diaphyseal femur.
N Engl J Med, 362 (2010), pp. 1761-1771
[20.]
J.A. Daccach, L.C. Morales, C. Soto, A. Llinás.
Fracturas subtrocantérica patológica asociada al uso crónico de bifosfonatos: reporte de caso.
Rev Col Ortop Traumatol, 25 (2011), pp. 59-63
[21.]
E. Shane, D. Burr, P.R. Ebeling, B. Abrahamsen, R.A. Adler, T.D. Brown, et al.
Atypical subtrochanteric and diaphyseal femoral fractures: Report of a task force of the American Society for Bone and Mineral Research.
J Bone Miner Res, 25 (2010), pp. 2267-2294
[22.]
J.W. Nieves, J.P. Bilezikian, J.M. Lane, T.A. Einhorn, Y. Wang, M. Steinbuch, et al.
Fragility fractures of the hip and femur: incidence and patient characteristics.
Osteoporos Int, 21 (2010), pp. 299-408
[23.]
R. Aspenberg.
Bisphosphonates and fatigue fractures.
IBMS BoneKEy, 6 (2009), pp. 465-469
[24.]
R. Rizzoli, K. Åkesson, M. Bouxsein, J.A. Kanis, N. Napoli, S. Papapoulos, et al.
Subtrochanteric fractures after long-term treatment with bisphosphonates: a European Society on Clinical and Economic Aspects of Osteoporosis and Osteoarthritis, and International Osteoporosis Foundation Working Group.
Osteoporos Int, 22 (2011), pp. 373-390
[25.]
Geusens.
R Bisphosphonates for Postmenopausal Osteoporosis: Determining Duration of Treatment.
Curr Osteoporosis Rep, 7 (2009), pp. 12-17
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