Bilateral femoral neck fractures in long-term steroid use for systemic lupus erythematosus and chronic lung disease.

Abstract

Bilateral femoral neck fractures present a rare injury. Only one report to our knowledge was not related to an acute severe traumatic event, and developed years after pelvic irradiation. Chronic steroid use may severely decrease bone strength, thus increasing the risk for such an injury. Patients with chronic lung disease and chronic inflammatory conditions are frequently treated with steroids such as prednisone at doses that may exceed 2.5 mg a day for long durations. Fractures at vulnerable sites such as the femoral neck may then follow without any severe trauma. Awareness of the detrimental effect of chronic steroid consumption on bone morphology, and familiarity with treatment alternatives to improve bone mass is important to prevent such a severe injury. We describe two cases of bilateral femoral neck fractures in women who were treated for years with orally administered prednisone. The rarity of such an injury of bilateral hip fractures and the fact that neither of the patients sustained major trauma, strongly suggests that both cases were related to impaired bone metabolism due to the effect of prolonged steroid consumption. The biological effects of different roots of steroid administration on bone turnover, as well as several strategies that can be implemented by clinicians to treat and prevent steroid induced osteoporosis and fractures, are further clarified in this article.