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Management of atypical femoral fracture in a patient with osteogenesis imperfecta
  1. Jing Yuan Tan1,
  2. Cherng Jye Seow2
  1. 1 Endocrinology, National University Singapore Yong Loo Lin School of Medicine, Singapore, Singapore
  2. 2 Endocrinology, Tan Tock Seng Hospital, Singapore, Singapore
  1. Correspondence to Dr Cherng Jye Seow, cherng_jye_seow{at}


Osteogenesis imperfecta (OI) is a generalised connective tissue disorder associated with low bone mass, bone fragility and increased susceptibility to fractures. First-line treatment to improve bone mineral density (BMD) is usually with bisphosphonates but long-term usage has been associated with uncommon complications such as atypical femoral fractures (AFF). Treatment with teriparatide in this situation has been reported with positive outcomes. However, choice of treatment after 2 years of teriparatide has not been well studied or reported. We describe a patient with OI treated with bisphosphonates for 9 years, who then suffered a spontaneous AFF, was subsequently started on teriparatide for 2 years followed by 6 monthly Denosumab. 1 year post-treatment with Denosumab, there was significant improvement in BMD, good fracture healing and no new fractures. This case highlights the potential use of denosumab following 2 years of teriparatide treatment in patients with OI with AFF.

  • calcium and bone
  • musculoskeletal and joint disorders
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  • Contributors JYT: drafted the manuscript. CJS: revised the manuscript for critically important intellectual content. Both authors: involved in writing up the case; took part in acquisition of data as well as analysed and interpreted the data; approved the final version of the manuscript to be published.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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