Bisphosphonate Use and Fractures in Adults with Hypophosphatasia
Autor: | Tim Cundy, Kate Rassie, Michael Dray, Toshimi Michigami |
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Jazyk: | angličtina |
Rok vydání: | 2019 |
Předmět: |
ALPL
Pediatrics medicine.medical_specialty Endocrinology Diabetes and Metabolism medicine.medical_treatment Osteoporosis Diseases of the musculoskeletal system Gene mutation OSTEOPOROSIS Bone remodeling Medicine Orthopedics and Sports Medicine In patient Orthopedic surgery Osteomalacia GENE MUTATIONS business.industry Hypophosphatasia Original Articles Bisphosphonate OSTEOMALACIA medicine.disease ATYPICAL FEMORAL FRACTURES HYPOPHOSPHATASIA RC925-935 Original Article business RD701-811 |
Zdroj: | JBMR Plus, Vol 3, Iss 10, Pp n/a-n/a (2019) JBMR Plus |
ISSN: | 2473-4039 |
Popis: | Adults with hypophosphatasia (HPP) may suffer femoral fractures resembling the atypical femoral fractures that can occur with long‐term bisphosphonate treatment, and there is an emerging consensus that bisphosphonates should not be used in adults with HPP and low bone mass. However, the spectrum of HPP in adults is wide: ranging from the severely affected—who commonly have osteomalacia—through to the minimally affected. The former typically have biallelic and the latter, heterozygous ALPL mutations. We have reviewed reports of fractures in adults with genetically proven HPP which suggest that the risk of fracture is at least 200‐fold greater in those with biallelic mutations. We also discuss two cases of postmenopausal women with heterozygous ALPL mutations. One had fractures and severe osteoporosis, but histology revealed no evidence of osteomalacia. The second had taken alendronate for 8 years, but despite profound suppression of bone turnover, histology again revealed no evidence of osteomalacia. The management of adults with HPP who have coexisting osteoporosis is challenging. More data are clearly needed, but we suggest that the risks of bisphosphonate therapy may be relatively low in patients who have heterozygous mutations and no histological evidence of osteomalacia. © 2019 The Authors. JBMR Plus published by Wiley Periodicals, Inc. on behalf of American Society for Bone and Mineral Research © 2019 The Authors. JBMR Plus published by Wiley Periodicals, Inc. on behalf of American Society for Bone and Mineral Research. |
Databáze: | OpenAIRE |
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