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We describe a patient who suffered an atypical periprosthetic femoral shaft fracture two years after surgical treatment for a typical osteoporotic femoral neck fracture. This patient had been suffering from rheumatoid arthritis (RA), steroid-induced diabetes, and steroid-induced osteoporosis, and had undergone longterm administration of glucocorticoids (GCs), bisphosphonates (BPs), and active vitamin D (aVD) analog. Prodromal pain and periprosthetic cortical stress reaction had occurred in the lateral cortex one month before she sustained the complete fracture. Histomorphometric analysis of a bone taken from just beneath the fracture site revealed the involvement of not severely suppressed bone turnover (SSBT) but osteomalacia. The serum concentration of 25-hydroxyvitamin D (25OHD) was low suggesting the status of vitamin D deficiency. Although periprosthetic fractures were excluded from the established definition of atypical femoral fractures (AFFs) of the American Society for Bone and Mineral Research (ASBMR), physicians should recognize that atraumatic atypical femoral fracture can occur even in a periprosthetic lesion during the postoperative management of osteoporosis-related fractures especially in patients with multiple comorbid conditions and vitamin D deficiency.

journal of rheumatic diseases and treatment

Pathological Relationship of Osteomalacia at the Site of Atypical Periprosthetic Femoral Shaft Fracture after Typical Femoral Neck Fracture Occurred in the Patient with Rheumatoid Arthritis: A Case Report