Atypical Fracture of the Sternum After Long-Term Alendronate Plus Cholecalciferol Treatment: A Case Report

A 55-year-old woman developed an atraumatic sternum fracture during treatment with alendronate for osteoporosis. The woman received alendronate 70 mg in combination with cholecalciferol 5600 IU once weekly, as well as nonsteroidal anti-inflammatory drugs. After 4 years of treatment, following a dors...

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Bibliographic Details
Published in:Drug safety - case reports 2017-12, Vol.4 (1), p.1-4, Article 5
Main Authors: Martín Arias, Luis H., García Ortega, Pilar, Sáinz Gil, María, Navarro García, Ester, Treceño Lobato, Carlos, Delgado Armas, Virginia
Format: Article
Language:English
Subjects:
Case Report
Case reports
Drug Safety and Pharmacovigilance
Fractures
Medicine
Medicine & Public Health
Monoclonal antibodies
Patient safety
Pharmaceuticals
Pharmacology
Pharmacology/Toxicology
Side effects
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Summary:A 55-year-old woman developed an atraumatic sternum fracture during treatment with alendronate for osteoporosis. The woman received alendronate 70 mg in combination with cholecalciferol 5600 IU once weekly, as well as nonsteroidal anti-inflammatory drugs. After 4 years of treatment, following a dorsal flexion with no direct thoracic trauma, the patient suffered a fracture of the sternum, with an X-ray revealing sternal body fracture. This fracture was seen to be transverse, noncomminuted and without displacement. Magnetic resonance imaging was carried out to rule out the presence of either a pathological fracture or a fracture resulting from osteoporotic fragility, and showed a triple sternal fracture involving the body, as well as the upper and lower manubrium of the sternum. This fracture presented the features of an atypical femur fracture, except for the location. The alendronate and cholecalciferol combination was discontinued and denosumab was prescribed. After the withdrawal of alendronate, the patient showed clinical improvement, with a decrease in pain, and is currently having routine checkups. The causality algorithm of the Spanish Pharmacovigilance System shows a score of 5, indicating a possible relationship between the patient’s sternum fracture and her use of the suspect drug (Naranjo scale 6 = probable).
ISSN:2199-1162
2198-977X
DOI:10.1007/s40800-017-0046-z