Title : Descriptive case study of an atypical fracture presentation in a postmenopausal lady with groin pain
Abstract:
A descriptive case study of a postmenopausal osteoporotic Asian lady who presented with prodromal groin pain and found to have a rare, atypical femoral fracture while on a background of chronic antiresorptive osteoporosis therapy of bisphosphonates and then denosumab. This demonstrates the following possible risk factors, such as Asian ethnicity, use of certain medications (e.g. denosumab and bisphosphonates) and femoral geometry, predicting a high risk of sustaining an atypical fracture, differential diagnoses to consider, major and minor criteria for diagnosis and discussion on both conservative and surgical management of an atypical fracture. In addition to stopping bisphosphonate therapy, avoidance of high impact exercises and gradual return to full weight bearing after surgical fixation of an atypical femoral fracture, the patient was able to successfully rehabilitate to her premorbid function. The study also urges the need to screen for contralateral limb atypical fracture and suggests preventive management of its occurrence through prophylactic intramedullary nailing of contralateral femur. The study takes into consideration of patients with osteoporosis who are at higher risk of typical fractures (e.g. history of fracture while on osteoporosis therapy, hip T score –2.5 or lower, older age of 70 years old and above), other strong risk factors for fracture such as smoking, alcohol use, corticosteroid use, rheumatoid arthritis and family history, WHO FRAX fracture risk score above the country-specific threshold) who may benefit from continuing antiresorptive osteoporotic therapy despite the small risk of sustaining an atypical fracture. This case highlights the need to balance between fracture reduction and sustaining an atypical fracture from continuing antiresorptive osteoporotic treatment.
