Effective treatment of a steroid-induced femoral neck fracture nonunion with a once-weekly administration of teriparatide in a rheumatoid patient: a case report
An 88-year-old female was referred to our hospital in February 2011 after a fall from her bed 3 days earlier. Her past medical history included colon cancer at the age of 67 years and gastric cancer at the age of 85 years. She suffers from rheumatoid arthritis (RA), with a drug history of 50 mg bucillamine and 5 mg prednisolone per day for more than 10 years. Two months prior to her fall, her prednisolone dosage had been reduced to 2.5 mg per day. Clinical and radiological examination revealed a Garden type II displaced femoral neck fracture. The patient underwent surgery with a Hansson hook-pin system within 3 h after her arrival (Fig. ).\nAt 3 months post-operatively, CT imaging suggested the presence of delayed union in the femoral neck, which was treated with LIPUS (Fig. ). At 11 months, the patient still complained of mild groin pain on ambulation. A diagnosis of nonunion was given but LIPUS therapy was discontinued because the patient rejected the therapy (Fig. ). Bone mineral density (BMD) tests of the right hip revealed severe osteoporosis measuring 38 % of the young adult mean, with a BMD score of 0.303 g/cm2 and a T score of −4.4.\nThe patient accepted treatment with a once-weekly injection of 56.5 μg chemically synthesized TPTD. At 18 months post-operatively, CT imaging after 20 consecutive weekly administrations of TPTD revealed signs of healing and the patient reported a gradual decrease in groin pain on ambulation (Fig. ). Complete union of the fracture was obtained at 23 months (Fig. ). Serum examination after 36 weekly injections of TPTD was as follows: C-reactive protein, 0.2 mg/dl; rheumatoid factor, 170 U/ml; alkaline phosphatase, 208 U/l; albumin, 4.0 g/dl; calcium, 8.8 mg/dl. The patient reported no side effects during the entire period of TPTD treatment.