《英文：一例长期应用帕米磷酸和唑来膦酸发生股骨骨折的病例报道》由会员分享，可在线阅读，更多相关《英文：一例长期应用帕米磷酸和唑来膦酸发生股骨骨折的病例报道（5页珍藏版）》请在金锄头文库上搜索。
1、CASE REPORTCase Report of Spontaneous, Nonspinal Fractures in a Multiple Myeloma Patient on Long-term Pamidronate and Zoledronic AcidGreg Wernecke this is in contrast to normal healthy bone (Fig. 5b). There was no evidence of osteomalacia. X-rays taken at 3 months postoperatively from her right tota
2、l hip arthroplasty demonstrated impaired healing at both fracture sites (Figs. 6a, b). In light of her profound bone inactivity (frozen bone), the patient was started on teripara- tide, and at 1-year follow-up, plain radiographs demonstrat- ed partial healing of both right and left subtrochanteric f
3、ractures (Fig. 6c). At this point, her DEXA scores revealed marked improvement (0.7 and 0.6 in L1L4 vertebrae and right forearm, respectively), and her laboratory values had begun to normalize from previous measurements (Table 1).DiscussionMultiple clinical trials show the efficacy and safety of bis
4、phosphonates in improving bone mass density and reducing fracture risk in multiple myeloma and osteoporotic patients. However, there are no studies beyond 10 years of treatment and no studies that show continued reduction in fracture risk after 5 years of treatment. The possibility of heightened fra
5、cture risk in patients on long-term bisphosph- onates has been considered in the past 2325. Another possibility is the adverse effect of other anticancer agents on bone turnover. However, there are some reports in the literature of fracture and delayed healing in otherwise healthy patients not recei
6、ving chemotherapy. Odvina et al. reported on nine patients who sustained spontaneous,Fig. 4. Transverse cut of T2-weighted, FSEIR (fat suppressed) MRI of the right thigh. There is decreased signal on the lateral cortical border of the femur approximately three times as wide as the medialcortex repre
7、senting significant cortical thickening. Furthermore, there is increased signal within the adjacent marrow cavity representing edemaFig. 5. a This photomicrograph is of the cancellous bone from the excised femoral head at time of arthroplasty. This is one of the onlyfields that showed any indication
8、 of remodeling activitya small region of osteoblastic activity at the bone surface near the asterisk while the majority of trabecular surfaces are stagnant or “frozen” (hematoxylin and eosin, 10). b This photomicrograph is of the cancellous bone from a typical hip arthroplasty specimen presented for
9、 comparison. Most of the surfaces show some degree of remodeling activity either with surface osteoblasts or osteoclasts (hematoxylin and eosin, 10)HSSJ (2008) 4: 123127125nonspinal fractures while on alendronate therapy 26. Six of these patients displayed delayed or absent fracture healing. Iliac c
10、rest bone biopsies in all nine patients revealed severe depression of bone formation with absence of double- tetracycline labeling. Schneider et al. reported a case of a previously healthy woman who experienced two nontrau- matic stress fractures, 4 years apart, while on alendronate therapy for appr
11、oximately 7 years 27. This patient went on to suffer a delayed union of a spiral femoral fracture that resulted from the stress fracture. Both fractures healed after several months of stopping bisphosphonate treatment. The therapeutic goal in medical treatment of multiple myeloma with bisphosphonate
12、s has been both to target osteoclast-mediated bone disease, including hypercalcemia of malignancy, bone metastases, and osteoporosis, and to gain additional antitumor effects. However, this class of drugs does not go without side effects including hypocal-cemia, injection site reaction, flu-like syn
13、drome, renal toxicity, ocular complications, and recently, numerous reports of osteonecrosis of the jaw 2829. Based on these risks and uncertainties, the Mayo Clinic Consensus Statement for Bisphosphonates in Multiple Myeloma recommends the cessation of bisphosphonate use if the patient has achieved
14、 response and is in a stable plateau phase of treatment 30.ConclusionPamidronate and zoledronic acid are two potent intravenous bisphosphonates used in the treatment of multiple myeloma as well as osteoporosis. While the concern for heightened fracture risk in a patient on long-term bisphosphonate t
15、reatment for malignancy has been previously noted, wepresent the first case of spontaneous, nonspinal fractures in a patient undergoing treatment for multiple myeloma. Though it is possible for these fractures to have been pathologic due to our patients underlying disease, we have imaging studies as
16、 well as gross and micropathological bone biopsies from the fracture sites showing complete remission from her multiple myeloma. These fracturescould also be osteoporotic insufficiency fractures; however, their unusual locations and the patients improved bone mass density and normal laboratory values indicate a different type of pathology. The pathology in this patient demonstrated decreased cellular activity on the cancellous bone surfaces, indicating decreased bone metabo
