Journal of Clinical Medicine Research, ISSN 1918-3003 print, 1918-3011 online, Open Access
Article copyright, the authors; Journal compilation copyright, J Clin Med Res and Elmer Press Inc
Journal website http://www.jocmr.org

Case Report

Volume 7, Number 11, November 2015, pages 901-906

Zoledronate Therapy for the Pathological Humeral Fracture in Polyostotic Fibrous Dysplasia: A Case Report

Figures

Figure 1.
Figure 1. X-ray images of the right femur. (a) Preoperative radiograph of the right femur showing a pathological subtrochanteric femoral fracture (arrow) and a diffuse fibrodysplastic lesion of the entire femur with the typical shepherd’s crook deformity. (b) Femoral fracture was fixed percutaneously with three titanium Kirschner wires through the great trochanter to the distal femoral condyle. (c) Radiograph 1 year after the procedure confirming bony union.
Figure 2.
Figure 2. X-ray images of the left humerus at the presentation. Plain radiography shows osteolytic lesions with slightly sclerotic septa in the left humeral shaft and metaphysis. A supracondylar fracture (arrow) is evident.
Figure 3.
Figure 3. The clinical course of zoledronate therapy. With supplementation including calcium (600 mg/day) and vitamin D (alfacalcidol 0.5 μg/day), 2 mg of intravenous zoledronate (Zometa®; Novartis, Tokyo, Japan) was administered at 5 months and 11 months after surgery for the right femoral fracture. Alkaline phosphatase (ALP) levels decreased from 2,118 to 1,366 IU/L and urine N-terminal cross-linking telopeptide of type I collagen (NTX) levels decreased from 1,492 to 319 nmol bone collagen equivalents/mmol creatinine (nmolBCE/mmolCr).
Figure 4.
Figure 4. X-ray images of the left humerus after 1 year from the zoledronate administration. Radiological thickening of the humeral shaft cortical bone, progressive ossification in the fibrodysplastic lesion, and periosteal bone formation (arrow) are observed. Fracture lines have completely disappeared (arrow head).

Table

Table 1. Laboratory Blood Test Results at First Admission
 
Total protein (g/dL)6.2Ca (mg/dL)8.7WBC9,800
Albumin (g/dL)3.7P (mg/dL)2.8RBC466 × 103
AST (IU/L)21Na (mmol/L)139Hb13.1
ALT (IU/L)17K (mmol/L)3.5Ht38.3
ALP (IU/L)2,118Cl (mmol/L)101Plt27.3 × 103
LDH (IU/L)126BUN (mg/dL)14.5FT3 (pg/mL)11.4
PTH (pg/mL)41Creatinine (mg/dL)0.11FT4 (ng/dL)4.14
Urine NTX (nmol bone collagen equivalents/mmol creatine)1,492Bone alkaline phosphatase (μg/L)136Total urine phosphate (g/day)0.54