Abstract

We encountered a patient undergoing hemodialysis who developed an atypical femoral fracture within 2 years after the start of denosumab therapy. The patient was a 75-year-old female who had been on corticosteroid therapy for the treatment of myasthenia gravis since the age of 60. After starting oral alendronate in 2013, she developed a left atypical femoral fracture in June 2016, which was treated with intramedullary nailing. Alendronate therapy was discontinued. In 2017, the patient started hemodialysis due to advanced kidney failure. Subsequently, she had multiple compression fractures of the thoracolumbar spine, which led to the start of denosumab injections in January 2018. In October 2019, she developed a right atypical femoral fracture, which was also treated with intramedullary nailing. Most antiosteoporotic drugs are contraindicated or should be administered with caution in patients with renal failure, and denosumab should be administered with monitoring for signs of hypocalcemia. The decision to recommend denosumab to a patient should be based on careful assessments of its risks and benefits, and administration of this agent should be accompanied by frequent follow-up, particularly in patients with a history of atypical femoral fracture.