英文：一例长期应用帕米磷酸和唑来膦酸发生股骨骨折的病例报道.pdf

HSSJ (2008) 4: 123– 127 DOI 10.1007/s11420-008-9077-4 CASE REPORT Case Report of Spontaneous, Nonspinal Fractures in a Multiple Myeloma Patient on Long-term Pamidronate and Zoledronic Acid Greg Wernecke Surena Namduri, MD Edward F. DiCarlo, MD Robert Schneider, MD Joseph Lane, MD Received: 13 May 2008/Accepted: 13 May 2008/ Published online: 16 July 2008 # Hospital for Special Surgery 2008 Abstract Pamidronate and zoledronic acid are two potent action of osteoclasts and preventing bone resorption, intravenous bisphosphonates used in the treatment of bisphosphonates have been shown to reduce bony compli- multiple myeloma as well as osteoporosis. While the cations and fractures in patients with multiple myeloma [ 1– concern for heightened fracture risk in a patient on long- 7]. In addition, by limiting endosteal resorption, bone term bisphosphonate treatment for malignancy has been marrow expansion of myeloma cells may be inhibited. previously noted, we present the first case of spontaneous, Zoledronic acid is a nitrogen-containing bisphosphonate that nonspinal fractures in a patient undergoing treatment for inhibits enzymes of the mavelonate pathway and conse- multiple myeloma. The patient had a positive 9-year history quently inhibits prenylation of small guanosine triphosphate- of bisphosphonate treatment and presented with sequential binding proteins, which eventually leads to secondary subtrochanteric stress fractures of the left and right femurs. osteoclast apoptosis [8– 11]. Due to its high potency, this Pathological reports of fracture site biopsies demonstrate bisphosphonate has become the first option in the treatment signs consistent with ametabolic bone and no mal