Atypical Femoral Fracture in an Osteogenesis Imperfecta Patient Successfully Treated with Teriparatide

OBJECTIVE: We report a case of a successfully healed atypical femoral fracture (AFF) following treatment with teriparatide in a patient with osteogenesis imperfecta (OI). To our knowledge no successful treatment of AFF's with teriparatide in this subpopulation has ever been described.METHODS: This is a case report of an AFF treated with teriparatide.RESULTS: The patient was treated with hormone replacement therapy for 18 years and bisphosphonates for nine years before suffering a spontaneous AFF in the form of a dislocated non-comminute transverse fracture of the right femoral shaft and an open reduction and internal fixation (ORIF) with a T2 Femoral Nail was done. Due to nonunion and another fracture distal to the nail she was re-operated with exchange ORIF and off label treatment with teriparatide 20 microgram/day was started. An x-ray one month later showed early signs of fracture healing. A subsequent x-ray 6 months after the last operation showed a solid healing of both right femoral fractures.CONCLUSION: This is a rare case that highly suggests a potential fracture healing effect of teriparatide treatment and highlights a potential significant practical therapeutic consideration in relation to the management of AFF with delayed healing.