Multiple fractures after low-energy trauma in an immunosuppressed lung transplant patient with severe osteoporotic bone texture—a challenge for traumatology and osteology

TL;DR

A lung transplant patient with severe osteoporosis suffered multiple fractures from a minor fall and was successfully treated with osteoanabolic drugs.

Contribution

Demonstrates successful osteosynthetic treatment and fracture healing using osteoanabolic therapy in a high-risk immunosuppressed patient.

Findings

Switching to osteoanabolic medication led to complete fracture consolidation over 6 months.

No new insufficiency fractures occurred during treatment.

Bone density did not improve despite successful fracture healing.

Abstract

Patients before and after lung transplantation often have osteoporosis with existing and recent symptomatic insufficiency fractures, which reduce the quality of life and increase general morbidity and mortality. Due to the reduced bone quality with a significantly increased fracture risk, even low-energy trauma results in the risk of acquiring multiple and complex fractures. The rarefied bone substance can be very challenging for subsequent osteosynthetic treatment. Antiosteoporotic medication is always necessary, and osteoanabolic therapy should be discussed in such cases. In the following, we report about the successful osteosynthetic treatment of an immunosuppressed patient with multiple fractures after a fall from low height. To support fracture healing with antiosteoporotic drug therapy, the patient was switched from antiresorptive to osteoanabolic medication, which resulted in complete fracture consolidation over the course of 6 months. There were also no new insufficiency fractures during this period; however, no improvement in bone density was achieved.

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