Abstract

Introduction: Atypical femoral fracture (AFF) may be associated with prolonged bisphosphonate. Any bisphosphonate after surgical fixation for AFF should not prescribe in this group of patients. Additionally, animal studies have shown that bisphosphonates suppress bone formation by lining cells, that is, bone modeling [1,2]. RANKL-inhibitor is one of the most effective treatment for osteoporosis after surgical intervention for AFF without bone modeling suppression.

Case presentation: A 78 years old female with prolonged oral bisphosphonate longer than 5 years sustained an atypical femoral fracture on left thigh by simple fall. She underwent surgical fixation with broad dynamic compression plate. One week after surgery, she fell again and she came with re-fracture around plate fixation. Fixation failure was managed by distal femoral Locking Compression Plate (LCP) with cable fixation and followed by RANKL inhibitor 2 weeks after surgery. Fracture completely united by 1 year after 2 doses of denosuma band patient can walk with a small limitation by cane.

Conclusion: RANKL inhibitor may be useful for osteoporotic treatment with enhancing bone modeling after surgical intervention for atypical femoral fracture.

Keywords: RANKL inhibitor; Atypical femoral fracture; Surgical fixation; Bone modeling