Published online Oct 20, 2014.
https://doi.org/10.12671/jkfs.2014.27.4.327
Multiple Stress Fractures Related to Low-dose Adefovir Dipivoxil Treatment in a Patient with Chronic Hepatitis B: A Case Report
Abstract
Stress fractures typically result from repeated abnormal mechanical loading to the bones. In particular, multiple stress fractures may occur in patients with systemic disease, such as rheumatoid arthritis, osteoporosis, or osteoarthritis. Adefovir dipivoxil (ADV), a nucleotide analogue of adenosine monophosphate, very rarely causes severe hypophosphatemia when using a low dosage of 10 mg daily for treatment of chronic hepatitis B. To the best of our knowledge, in English literature, this is the first report of multiple stress fractures in a chronic hepatitis B patient who has been treated with a low dosage of ADV. We think it is important to consider that use of ADV in a patient with chronic hepatitis B could be a risk factor for stress fractures.
Fig. 1
Magnetic resonance image showed diffuse high signal intensity at the right distal tibia and talus (A), left distal tibia and talus (B), and distal femur and proximal tibia (C) on coronal T2-weighted images.
Fig. 2
(A) Whole body bone scan taken at the initial visit showed multiple hot uptakes at multiple ribs, right sacroiliac joint, both distal femurs and proximal tibias, and both distal tibias and tali. (B) Whole body bone scan taken at one year after treatment showed decreased uptake.
Financial support: None.
Conflict of interest: None.
References
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Bron JL, van Solinge GB, Langeveld AR, Jiya TU, Wuisman PI. Three previously healthy persons with a stress fracture. Ned Tijdschr Geneeskd 2007;151:621–626.
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Izzedine H, Hulot JS, Launay-Vacher V. Adefovir Dipivoxil International 437 Study Group; Adefovir Dipivoxil International 438 Study Group. Renal safety of adefovir dipivoxil in patients with chronic hepatitis B: two double-blind, randomized, placebo-controlled studies. Kidney Int 2004;66:1153–1158.
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