Atypical fracture of metatarsal bone in a patient with multiple myeloma who was treated long-term with bisphosphonates
Authors:
Z. Adam 1; A. Šprláková‑ puková 2; R. Chaloupka 3; M. Krejčí 1; L. Pour 1; Z. Král 1; J. Mayer 1
Authors place of work:
Interní hematologická a onkologická klinika Lékařské fakulty MU a FN Brno, pracoviště Bohunice, přednosta prof. MU Dr. Jiří Mayer, CSc.
1; Radiologická klinika Lékařské fakulty MU a FN Brno, pracoviště Bohunice, přednosta prof. MU Dr. Vlastimil A. Válek, CSc., MBA
2; Ortopedická klinika Lékařské fakulty MU a FN Brno, pracoviště Bohunice, přednosta doc. MU Dr. Martin Repko, Ph. D.
3
Published in the journal:
Vnitř Lék 2013; 59(11): 1022-1026
Category:
Case Report
Summary
The first reports found in professional literature on the use of bisphosphonates as a treatment date back to 1972. We found the first report on the use of a bisphosphonate comprising nitrogen in its molecule in a publication from 1990. Some of the adverse effects of the particular types of bisphosphonates were described in the registration studies. At least two serious adverse effects of this group of medicines had not been described until 2000. We found the first description of jaw osteonecrosis in relation to the long‑term application of bisphosphonates in a publication from 2002 and we found the first description of an atypical bone fracture originating without a corresponding traumatic event in a location with no presence of an osteolytic focus in an article from 2006. These so‑ called atypical fractures, which are also called fractures without a corresponding traumatic event (low energy fractures), have been described to have occurred in femurs, in the pelvis and less frequently in the metatarsal area. “Atypical fractures” are linked to long‑term administration of bisphosphonates, which significantly increases the bone density and impedes osteolysis but it simultaneously increases the fragility of bones and decreases their flexibility. The definition of an atypical fracture of the skeleton emphasises the fact that such fractures occur with an inadequately minimal force (energy) in the aforementioned predilection locations. In the following text we are describing a patient who has been treated for a multiple myeloma with an atypical fracture of the Metatarsal bone 2. This fracture occurred during a regular walk without any excessive load and the patient could not recall any corresponding injury or longer walking. The patient had been administered bisphosphonates for 34 months before the atypical metatarsal fracture occurred. The metatarsal bone fracture was treated through a non‑weight‑ bearing regime for the sole and the pain diminished within a single month. In comparison with the published data of atypical fractures, our case concerns a short interval between initiation of the bisphosphonate administration and the occurrence of the atypical fracture. In the available literature these fractures are described after more than a five‑year application of a bisphosphonate. New pain in the bearing skeleton in patients treated with bisphosphonates are therefore always subject to an imaging examination among others to exclude an atypical fracture due to an increased fragility of the bone.
Key words:
bisphosphonate – atypical fracture (low energy fracture) – clodronate – pamidronate – zoledronate – lenalidomide – osteoporosis – monoclonal immunoglobulin
Zdroje
1. Ščudla V, Bačovský J, Indrák K et al. Results of therapy and changing prognosis of multiple myeloma during the last 40 years in the region of North and Middle Moravia: group of 562 patients. Hematol J 2003; 4: 351– 357.
2. Ščudla V, Minařík J, Pika T. Light chain deposition disease. Vnitř Lék 2012; 58: 38– 43.
3. Ščudla V, Herman M, Minařík J et al. Přínos celotělovém magnetické rezonance pro diagnostiku monoklonální gamapatie nejistého významu, mnohočetného myelomu a stanovení Durie‑ Salmon Plus stagingového systému. Vnitř Lék 2011; 57: 52– 60.
4. Mysliveček M, Bačovský J, Ščudla V et al. 18F‑ FDG PET/ CT a 99mTc‑ MIBI scintigrafie při hodnocení pacientů s mnohočetným myelomem a monoklonální gamapatií nejistého významu. Klin Onkol 2010; 23: 325– 331.
5. Bačovský J, Myslivecek M, Ščudla V et al. Tc‑ 99m MIBI scintigrafie u mnohočetného myelomu. Clin Nucl Med 2010; 35: 667– 670.
6. Ščudla V, Petrová P, Minařík J et al. Příspěvek k hodnocení plazmatických hladin vybraných biologických parametrů u monoklonální gamapatie nejistého významu a u pacientů s mnohočetným myelomem Vnitř Lék 2010; 56: 591– 601.
7. Ščudla V, Zemanova M, Minarik J et al. International prognostic index (IPI) – a critical comparison with five multiple myeloma staging systems in the group of 270 patients treated by conventional chemotherapy. Neoplasma 2006; 53: 277– 284.
8. Bačovský J, Ščudla V, Vytřasová M et al. Monitoring of bone resorption and bone formation in multiple myeloma. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2002; 146: 59– 61.
9. Vytřasová M, Ščudla V, Nekula J et al. Magnetická rezonance při vyšetřování páteře u pacientů s mnohočetným myelomem. Vnitř Lék 2001; 47: 694– 698.
10. Bačovský J, Ščudla V, Pospíšil Z et al. Single photon bone densitometry in multiple myeloma. Acta Univ Palacki Olomuc Fac Med 1999; 142: 83– 84.
11. Saville PD, Heaney R. Treatment of osteoporosis with diphosphonates. Semin Drug Treat 1972; 2: 47– 50.
12. Bonjour JP, Fleisch HA. Diphosphonates and vitamin‑D metabolism in Paget’s disease. Lancet 1973; 2: 375– 376.
13. Fromm G, Schajowicz F, Mautalen CA. Letter: Disodium ethane‑ 1– hydroxy‑ 1,1– diphosphonate (E.H.D.P.) in Paget’s disease. Lancet 1975; 2: 666.
14. Heaney RP, Saville PD. Etidronate disodium in postmenopausal osteoporosis. Clin Pharmacol Ther 1976; 20: 593– 604.
15. Siris ES, Sherman WH, Baquiran DC et al. Effects of dichloromethylene diphosphonate on skeletal mobilization of calcium in multiple myeloma. N Engl J Med 1980; 302: 310– 315.
16. Charhon S, Chapuy MC, Valentin‑Opran Aet al. Treatment of hypercalcemia of myelomatous origin with intravenous diphosphonates. Presse Med 1983; 12: 2983– 2986.
17. Jung A, Chantraine A, Donath A et al. Use of dichloromethylene diphosphonate in metastatic bone disease. N Engl J Med 1983; 308: 1499– 1501.
18. Kanis JA, Paterson AD, Russell RG. The use of diphosphonates in myeloma. Br J Haematol 1983; 53: 688– 690.
19. Delmas PD, Charhon S, Chapuy MC et al. Long‑term effects of dichloromethylene diphosphonate (CI2MDP) on skeletal lesions in multiple myeloma. Metab Bone Dis Relat Res 1982; 4: 163– 168.
20. Man Z, Otero AB, Rendo P et al. Use of pamidronate for multiple myeloma osteolytic lesions. Lancet 1990; 335: 663.
21. Merlini G, Parrinello GA, Piccinini L et al. Long‑term effects of parenteral dichloromethylene bisphosphonate (CL2MBP) on bone disease of myeloma patients treated with chemotherapy. Hematol Oncol 1990; 8: 23– 30.
22. Bonjour JP, Philippe J, Guelpa G et al. Bone and renal components in hypercalcemia of malignancy and responses to a single infusion of clodronate. Bone 1988; 9: 123– 130.
23. Attardo‑ Parrinello G, Merlini G, Pavesi F et al. Effects of a new aminodiphosphonate (aminohydroxybutylidene diphosphonate) in patients with osteolytic lesions from metastases and myelomatosis. Comparison with dichloromethylene diphosphonate. Arch Intern Med 1987; 147: 1629– 1633.
24. Adam Z, Ševčík P, Vorlíček J et al. Kostní nádorová choroba. Praha: Grada 2004.
25. Tomíška M, Adam Z, Prokeš B et al. Bone mineral density in multiple myeloma patients after intravenous clodronate therapy. Acta Med Austriaca 2001; 28: 38– 43.
26. Zajíčková K. Primární hyperparathyreidismus jako příčina hyperkalcemie u pacientky s karcinomem prsu a hyperkalcémií. Čas Lék Česk 2010; 149: 546– 548.
27. Fínek J, Prausová J, Cmejlová V et al. IKARUS Projekt – incidence kostních komplikací u pacientek s karcinomem prsu. Retrospektivní analýza pacientů v centrech České a Slovenské republiky. Klin Onkol 2009; 22: 154– 162.
28. Málek Z. Přínos ibandronatu u léčby postmenopauzální osteoporózy. Vnitř Lék 2007; 53: 1114– 1118.
29. Lastůvková I, Adam Z. Dotazníkový průzkum tolerance a nežádoucích účinků kloronatu u pacientů s mnohočetným myelomem. Vnitř Lék 2002; 48: 1049– 1053.
30. Fojtík Z, Kandusová M. Bisfosfonáty při léčbě osteoporózy. Vnitř Lék 1997; 43: 696– 699.
31. Slabý J, Špička I, Hulejová H et al. Účinek klodronatu u pacientů s mnohočetným myelomem. Hodnocení specifických markerů kostní resorpce. Čas Lék Česk 1997; 136: 57– 60.
32. Ruggiero SL, Mehrotra B, Rosenberg TJ et al. Osteonecrosis of the jaws associated with the use of bisphosphonates: a review of 63 cases. J Oral Maxillofac Surg 2004; 62: 527– 534.
33. Migliorati CA. Bisphosphonate‑associated oral osteonecrosis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2005; 99: 135.
34. Adam Z, Kozumpliková M, Pour L et al. Osteonekróza čelisti v průběhu léčby mnohočetného myelomu a podávání bisfosfonátů. Vnitř Lék 2006; 52: 176– 180.
35. Machálka M. Osteonekróza čelisti následují po kompletní protinádorové léčby a podávání bisfosfonátů. Vnitř Lék 2006; 52 (79Suppl 2), 81– 82.
36. Visekruna M, Wilson D, McKiernan FE. Severely suppressed bone turnover and atypical skeletal fragility. J Clin Endocrinol Metab 2008; 93: 2948– 2952.
37. Kwek EB, Koh JS, Howe TS. More on atypical fractures of the femoral diaphysis. N Engl J Med 2008; 359: 316– 317.
38. Lee P, Seibel MJ. More on atypical fractures of the femoral diaphysis. N Engl J Med 2008; 359: 317– 318.
39. Whyte MP. Atypical femoral fractures, bisphosphonates, and adult hypophosphatasia. J Bone Miner Res 2009; 24: 1132– 1134.
40. Abrahamsen B, Eiken P, Eastell R. Subtrochanteric and diaphyseal lemur fractures in patients treated with alendronate: a register‑based national cohort study. J Bone Miner Res 2009; 24: 1095– 1102.
41. Abrahamsen B. Bisphosphonate adverse effects, lessons from large databases. Curr Opin Rheumatol 2010; 22: 404– 409.
42. Girgis CM, Sher D, Seibel MJ. Atypical femoral fractures and bisphosphonate use. N Engl J Med 2010; 362: 1848– 1849.
43. Lee JK. Bilateral atypical femoral diaphyseal fractures in a patient treated with alendronate sodium. Int J Rheum Dis 2009; 12: 149– 154.
44. Black DM, Kelly MP, Genant HK et al. Fracture Intervention Trial Steering Committee; HORIZON Pivotal Fracture Trial Steering Committee. Bisphosphonates and fractures of the subtrochanteric or diaphyseal femur. N Engl J Med 2010; 362: 1761– 1771.
45. Breglia MD, Carter JD. Atypical insufficiency fracture of the tibia associated with long‑term bisphosphonate therapy. J Clin Rheumatol 2010; 16: 76– 78.
46. Compston JE. Bisphosphonates and atypical femoral fractures: a time for reflection. Maturitas 2010; 65: 3– 4.
47. Somford MP, Draijer FW, Thomassen BJ et al. 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 2009; 24: 1736– 1740.
48. Agarwal S, Agarwal S, Gupta P et al. Risk of atypical femoral fracture with long‑term use of alendronate (bisphosphonates): a systemic review of literature. Acta Orthop Belg 2010; 76: 567– 571.
49. Charopoulos I, Orme S, Giannoudis PV. Fracture risk associated with chronic use of bisphosphonates: evidence today. Expert Opin Drug Saf 2011; 10: 67– 76.
50. Rizzoli R, Akesson K, Bouxsein M 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 Report. Osteoporos Int 2011; 22: 373– 390.
51. Rogers LF, Taljanovic M. FDA statement on relationship between bisphosphonate use and atypical subtrochanteric and femoral shaft fractures: a considered opinion. AJR Am J Roentgenol 2010; 195: 563– 566.
52. Schneider JP. Should bisphosphonates continued indefinitely. An unusual fracture in healthy woman on long‑term bisphosphonate. Geriatrics 2006; 61: 31– 33.
53. Wernecke G, Namduri S, DiCarlo EF et al. Case report of spontaneous nonspinal fracture in multiple myeloma pacient on long term pamidronate and zoledronic acid. HSS J 2008; 4: 123– 127.
54. Grasko JM, Hermann RP, Vasikaran SD. Recurrent low‑ energy femoral Shift fratures and osteonecrosis of the jaw in a case of multiple myeloma treated with bisphosphonates. J Oral Maxillofac Surg 2009; 67: 645– 649.
55. Waterman GN, Yellin O, Jamshidinia K et al. Metatarsal stress fractures in patients with multiple myeloma treated with long‑term bisphosphonates: a report of six cases. J Bone Joint Surg Am 2011; 93: e106.
56. Pradhan P, Saxena V, Yadav A et al. Atypical metatarsal fracture in a patient on long term bisphosphonate therapy. Indian J Orthop 2012; 46: 589– 592.
57. Puhaindran ME, Farooki A, Steensma MR et al. Atypical subtrochanteric femoral fractures in patients with skeletal malignant involvement treated with intravenous bisphosphonates. J Bone Joint Surg Am 2011; 93: 1235– 1242.
58. Chang ST, Tenforde AS, Grimsrud CD et al. Atypical femur fractures among breast cancer and multiple myeloma patients receiving intravenous bisphosphonate therapy. Bone 2012; 51: 524– 527.
59. Hájek R. za Českou myelomovou skupinu: Diagnostika a léčba mnohočetného myelomu. Transfuze a hematologie dnes 2012; 18: 1– 90.
Štítky
Diabetology Endocrinology Internal medicineČlánok vyšiel v časopise
Internal Medicine
2013 Číslo 11
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