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Bisphosphonate-Induced Atypical Femoral Fractures: Pathogenesis Insights and the Role of Bioactive Collagen Peptides – A Case Report

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Journal of Clinical Orthopaedics | Vol 9 | Issue 2 |  July-December 2024 | page: 118-122 | Somasekhara Reddy Nallamilli, Mohan Krishna Althuri, Shruti Patwal, Manish R Garg

DOI: https://doi.org/10.13107/jcorth.2024.v09i02.690

Submitted Date: 10 Aug 2024, Review Date: 12 Sep 2024, Accepted Date: 15 Sep 2024 & Published Date: 10 Dec 2024

Author: Somasekhara Reddy Nallamilli [1], Mohan Krishna Althuri [1], Shruti Patwal [2], Manish R Garg [3]

[1] Department of Orthopedics, Apollo Hospitals, Hyderabad, Telangana, India,
[2] Department of Medical Affairs, Universal NutriScience, Mumbai, Maharashtra, India,
[3] Department of Medical Affairs, Universal NutriScience, Pharmacology, Mumbai, Maharashtra, India

Address of Correspondence

Dr. Manish R Garg,
Department of Medical Affairs, Universal NutriScience, Pharmacology, Mumbai, Maharashtra, India
E-mail: manish_rgarg@yahoo.co.in

Abstract

Introduction: Bisphosphonates (BPs) have emerged as the mainstay of osteoporosis treatment. However, over the past 10 years, atypical femoral fractures (AFFs) have been identified as a possible side effect of BP.

Case Report: A 73-year-old male with a history of prostate carcinoma and an isolated rib metastasis was being treated with zoledronic acid. Despite a successful intramedullary nail fixation and a healed fracture, 5 months later, he developed another fracture in the same femur in the subtrochanteric area. This case report delves into the intricate pathogenesis of BP-induced atypical femoral fractures (AFF) and explores the potential role of bioactive collagen peptides in their pathogenesis.

Conclusion: Significant challenges exist in diagnosing and managing BP-induced AFFs. Using anabolic agents and bioactive collagen peptides is a successful therapeutic intervention for these patients.

Keywords: Collagen peptides, nutraceuticals, osteoporosis, bisphosphonate-induced atypical fractures.

 

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How to Cite this article: Nallamilli SR, Althuri MK, Patwal S, Garg MR. Bisphosphonate-Induced Atypical Femoral Fractures: Pathogenesis Insights and the Role of Bioactive Collagen Peptides – A Case Report. Journal of Clinical Orthopaedics July-December 2024;9(2):118-122.

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Comparative Study of BMD in Type 2 Diabetic and Non-diabetic Male Patients

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Journal of Clinical Orthopaedics | Vol 9 | Issue 1 |  January-June 2024 | page: 28-34 | Jata Shankar Kumar, Mohd Danish, Vikash Singh

DOI: https://doi.org/10.13107/jcorth.2024.v09i01.628

Author: Jata Shankar Kumar [1], Mohd Danish [1], Vikash Singh [1]

[1] Department of Orthopedics, Max Superspeciality Hospital, Ghaziabad, Uttar Pradesh, India.

Address of Correspondence
Dr. Mohd Danish,
Department of Orthopedics, Max Superspeciality Hospital, Ghaziabad, Uttar Pradesh, India.
E-mail: danish.shan@gmail.com

Abstract

Introduction: Osteoporosis and diabetes are both common human diseases. The prevalence of both is increasing individually and in combination, due to better detection methods and changing definitions. Due to the different pathogenesis of Type 1 and Type 2 diabetes mellitus (T2DM), one of which is a predominant autoimmune process while the other mainly a metabolic disorder, it is not surprising that there is no uniform entity of diabetic bone disease as such, although such term has been proposed in the past but never gained momentum. Paradoxically, an increased risk of osteoporotic fracture in T2DM has been repeatedly demonstrated and this was independent of bone mineral density (BMD). This association with fracture adds uncertainty around the actual association between diabetes mellitus and BMD.
This study aims to study the population of diabetes at tertiary care center when they are compared with non-diabetics in terms of BMD.
Aims of Study: The aim of this study was to determine the prevalence of osteopenia and osteoporosis in T2DM and non-diabetic male patients using Dual Energy X-ray absorptiometry (DEXA scan).
Materials and Methods: Patients for the study included male patients between 40 and 60 years of age group attending outpatient department, health checkup, and admitted in the ward of Saifee Hospital, Department of Medicine. In 200 (100 type 2 diabetic males and 100 non-diabetic males), DEXA Scan was performed in the Department of Imaging, Saifee Hospital from June 2017 to April 2019.
Results: Type 2 diabetics were significantly associated with the presence of osteoporosis compared to non-diabetics (P = 0.001). Type 2 diabetics were significantly associated with body mass index (BMI) >25 (P = 0.0) and diabetics had a significantly higher BMI compared to non-diabetics (P = 0.0001). Type 2 diabetics above 50 years of age were significantly associated with osteoporosis (P = 0.000) and diabetics with osteoporosis were significantly older compared to diabetics without osteoporosis (P = 0.0018).
Conclusion: The study concluded that there is a correlation between T2DM, increasing age, glycemic control, increased BMI, increased calcium levels, and decreased BMD. Thus, physician treating diabetes must anticipate decreased BMD and rule out or correct all of these factors in patients of diabetes to prevent the complications of decreased BMD in these groups of patients. Therefore, early detection and treatment of osteoporosis/osteopenia by estimation of BMD in Type 2 diabetic males, strict diabetic control with target hemoglobin A1c <6.5, weight control with target BMI <25, supplementation with Vitamin D3 should be advocated.
Keywords: Diabetes, osteoporosis, dual-energy X-ray absorptiometry scan.

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How to Cite this article: Kumar JS, Danish M, Singh V. Comparative Study of BMD in Type 2 Diabetic and Non-diabetic Male Patients. Journal of Clinical Orthopaedics 2024 January-June;9(1):28-34.

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Vertebral Fragility Fractures in Osteoporosis – A Comprehensive Review on its Management

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Journal of Clinical Orthopaedics | Vol 7 | Issue 1 |  Jan-Jun 2022 | page: 67-76 | Vibhu Krishnan Viswanathan, Rishi M Kanna, Ajoy Prasad Shetty

DOI:10.13107/jcorth.2022.v07i01.477

Author: Vibhu Krishnan Viswanathan [1], Rishi M Kanna [1], Ajoy Prasad Shetty [1]

[1] Department of Orthopaedics and Spine Surgery, Ganga Hospital, Coimbatore, Tamil Nadu, India

 

Address of Correspondence
Dr. Rishi M Khana,
Department of Orthopaedics and Spine Surgery, Ganga Hospital, Coimbatore, Tamil Nadu, India.
E-mail: rishiortho@gmail.com

Abstract

Introduction: Approximately 20% of individuals older than 50 years of age have been reported to present with vertebral fragility fractures (VFF) – a prevalence which is anticipated to steadily increase in future. VFF is associated with disabling pain, significant impairment of quality of life, reduced ambulatory capacity, impaired social interactions, and poor quality of sleep. Early detection, appropriate management, evaluation of osteoporosis, and prevention of future fragility fractures would form the crux of treatment. Nevertheless, there is no consensus on what constitutes the ideal management protocol for symptomatic VFF.

Methods: Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines were used to prepare this review. A detailed review of the literature was performed using PubMed, EMBASE, MEDLINE, and Cochrane Database of Systematic Reviews, which were searched for eligible studies with terms “treatment of VEF,” “osteoporotic vertebral fracture (OVF),” “management of osteoporotic compression fracture,” “imaging in OVF,” “percutaneous vertebral augmentation,” and “conservative treatment of OVF” from inception to November 2021. Duplicate studies, case reports, and letters to the editor were excluded from the study.

Results: A total of 286 studies were identified using our search criteria. Of these, 142 were duplicates and 107 did not meet inclusion criteria. After removal of these articles through various stages of screening, a total of 37 studies were finally included in the review. Plain radiographs, computed tomography (CT), and magnetic resonance imaging (MRI) are helpful in the diagnosis, evaluation, and management of these fractures. Radiologically, unstable VFFs need to be identified based on the following criteria (>50% vertebral height loss, kyphosis ≥25–35°, substantial retropulsion of bony fragments, significant bony, or ligamentous posterior column injuries). Conservative treatment (which includes analgesics, orthoses, and early mobilization) has remained the traditional way of treating these fractures. More recent systematic reviews have demonstrated a significant improvement in early pain control, vertebral height restoration, and ambulation with percutaneous augmentation (PKP or PVP) procedures. These studies have recommended cement augmentation in patients with intractable pain, not responding to medications. Surgical stabilization is recommended in elderly patients with pseudoarthrosis, substantial intervertebral instability, intractable pain with vertebral collapse, neurological deficit, and kyphosis. The need for long-term medical therapy to improve the bone density cannot be understated.

Conclusion: A high index of suspicion is necessary to diagnose VFFs in elderly patients with back pain. Conservative treatment has remained the traditional way of treating these fractures. Recent evidence shows early pain control and better vertebral height restoration with cement augmentation procedures (PKP or PVP). Open surgical stabilization can be helpful in a subset of patients with substantial intervertebral instability, deformity, and neuro-deficit.

Keywords: Osteoporosis, vertebral fragility fractures, cement augmentation, kyphosis

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How to Cite this article: Krishnan V, Kanna RM, Shetty AP. Vertebral Fragility Fractures in Osteoporosis – A Comprehensive Review on its Management. Journal of Clinical Orthopaedics Jan-Jun 2022;7(1):67-76.

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