[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"doc-seo-443579-105":3,"detail-sidebar-cat-0-en-105":80,"doc-detail-443579-en":130},{"code":4,"msg":5,"data":6},0,"ok",{"site_id":7,"language":8,"slug":9,"title":10,"keywords":11,"description":12,"schema_data":13,"social_meta":73,"head_meta":75,"extra_data":77,"updated_unix":79},105,"en","atypical-fracture-from-bisphosphonate-use-in-hypophosphatasia-with-improved-bone-response-to-teriparatide-therapy","Atypical Fracture From Bisphosphonate Use in Hypophosphatasia With Improved Bone Response to Teriparatide Therapy","","Hypophosphatasia is a rare metabolic bone disorder often mistaken for other conditions. A middle-aged woman was initially misdiagnosed with rickets, later reconsidered as osteogenesis imperfecta, and treated with zoledronate, after which she developed atypical femoral fractures. After switching to teriparatide therapy, her bone mineral density improved markedly. Persistently low alkaline phosphatase with fragility or atypical fractures should trigger evaluation for hypophosphatasia, and antiresorptives such as bisphosphonates may precipitate atypical fractures in this setting. Disease-specific therapy is asfotase alfa, and anabolic treatment can improve BMD in selected adults when it is unavailable.",{"@graph":14,"@context":72},[15,34,55],{"@type":16,"itemListElement":17},"BreadcrumbList",[18,23,27,31],{"item":19,"name":20,"@type":21,"position":22},"https://docshare.wps.com","Home","ListItem",1,{"item":24,"name":25,"@type":21,"position":26},"https://docshare.wps.com/document/","Document",2,{"item":28,"name":29,"@type":21,"position":30},"https://docshare.wps.com/document/healthcare/","Healthcare",3,{"item":32,"name":10,"@type":21,"position":33},"https://docshare.wps.com/document/atypical-fracture-from-bisphosphonate-use-in-hypophosphatasia-with-improved-bone-response-to-teriparatide-therapy/443579/",4,{"url":32,"name":10,"@type":35,"image":36,"author":41,"headline":10,"publisher":44,"fileFormat":47,"inLanguage":8,"description":12,"dateModified":48,"datePublished":49,"encodingFormat":47,"isAccessibleForFree":50,"interactionStatistic":51},"DigitalDocument",{"url":37,"@type":38,"width":39,"height":40},"https://docshare.wps.com/thumbnails/atypical-fracture-from-bisphosphonate-use-in-hypophosphatasia-with-improved-bone-response-to-teriparatide-therapy/443579.png","ImageObject",300,407,{"name":42,"@type":43},"Margaret","Person",{"url":19,"name":45,"@type":46},"DocShare","Organization","application/pdf","2026-09-30","2026-09-29",true,{"@type":52,"interactionType":53,"userInteractionCount":26},"InteractionCounter",{"@type":54},"ViewAction",{"@type":56,"mainEntity":57},"FAQPage",[58,64,68],{"name":59,"@type":60,"acceptedAnswer":61},"What condition links low alkaline phosphatase and atypical fractures in this report?","Question",{"text":62,"@type":63},"Hypophosphatasia (HPP). The case highlights persistently low alkaline phosphatase together with fragility or atypical fractures as a prompt for evaluating HPP.","Answer",{"name":65,"@type":60,"acceptedAnswer":66},"How did bisphosphonate treatment relate to the fractures described?",{"text":67,"@type":63},"The patient developed fragility fractures while receiving bisphosphonate therapy (zoledronic acid). The report emphasizes that antiresorptives may precipitate atypical fractures in hypophosphatasia and should be avoided.",{"name":69,"@type":60,"acceptedAnswer":70},"What therapy improved bone mineral density after the bisphosphonate-associated fractures?",{"text":71,"@type":63},"Teriparatide therapy. After switching to teriparatide (20 mcg subcutaneously daily), her BMD improved significantly, with DXA measurements summarized over time in Table 1.","https://schema.org",{"og:url":32,"og:type":74,"og:title":10,"og:site_name":45,"og:description":12},"article",{"robots":76,"canonical":32},"index,follow",{"doc_id":78,"site_id":7},443579,1790766196,{"code":4,"msg":81,"data":82},"success",[83,87,91,95,100,105,109,114,119,122,126],{"id":22,"doc_module":4,"doc_module_name":25,"category_name":84,"show_sort_weight":85,"slug":86},"Story & Novel",90,"story-novel",{"id":26,"doc_module":4,"doc_module_name":25,"category_name":88,"show_sort_weight":89,"slug":90},"Literature",80,"literature",{"id":33,"doc_module":4,"doc_module_name":25,"category_name":92,"show_sort_weight":93,"slug":94},"Exam",70,"exam",{"id":96,"doc_module":4,"doc_module_name":25,"category_name":97,"show_sort_weight":98,"slug":99},5,"Comic",60,"comic",{"id":101,"doc_module":4,"doc_module_name":25,"category_name":102,"show_sort_weight":103,"slug":104},6,"Technology",50,"technology",{"id":106,"doc_module":4,"doc_module_name":25,"category_name":29,"show_sort_weight":107,"slug":108},7,40,"healthcare",{"id":110,"doc_module":4,"doc_module_name":25,"category_name":111,"show_sort_weight":112,"slug":113},8,"Research & Report",30,"research-report",{"id":115,"doc_module":4,"doc_module_name":25,"category_name":116,"show_sort_weight":117,"slug":118},9,"Religion & Spirituality",20,"religion-spirituality",{"id":117,"doc_module":4,"doc_module_name":25,"category_name":120,"show_sort_weight":117,"slug":121},"World Cup","world-cup",{"id":123,"doc_module":4,"doc_module_name":25,"category_name":124,"show_sort_weight":123,"slug":125},10,"Lifestyle","lifestyle",{"id":127,"doc_module":4,"doc_module_name":25,"category_name":128,"show_sort_weight":96,"slug":129},19,"General","general",{"code":4,"msg":81,"data":131},{"doc_id":78,"user_id":132,"nickname":42,"user_avatar":133,"doc_module":4,"category_id":106,"category_name":29,"doc_title":10,"doc_description":12,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":26,"is_deleted":4,"is_public":22,"is_downloadable":22,"audit_status":22,"page_count":33,"language":139,"language_code":8,"site_id":7,"html_lang":8,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":12,"update_tm":143,"read_time":123},137451207643,"https://ap-avatar.wpscdn.com/davatar_3d24733baf745e90a7e4bdd5f77d97b2","Atypical Fracture From Bisphosphonate Use in Hypophosphatasia With Improved Bone Response to Teriparatide Therapy  \nEdwin Mora Garzon, 1 Daniel Betancourt Zuluaga,2 Juan David Salazar Ospina,3 and Sebastián López Velásquez4  \n1 Division of Endocrinology and Metabolism, Department of Internal Medicine and Epidemiology, S. E. S. Hospital Universitario de Caldas, Universidad de Caldas, Manizales 170003, Colombia  \n2Research Group on Geriatrics and Gerontology, Faculty of Health Sciences, Universidad de Caldas, Manizales 170003, Colombia 3 Department of Internal Medicine, Universidad de Caldas, Manizales 170003, Colombia  \n4Medical Research Group, Faculty of Health Sciences, Universidad de Manizales 170003, Manizales, Colombia  \nCorrespondence: Edwin Mora Garzon, MD, MSc, SES Hospital Universitario de Caldas, Calle 48 No 25–71, Manizales 170003, Colombia. Email:  \n[endocrinologiaemg@gmail.com](endocrinologiaemg@gmail.com).  \nAbstract  \nHypophosphatasia is a rare metabolic bone disorder that is often misdiagnosed. We present the case of a middle-aged woman initially misdiagnosed with rickets and later as osteogenesis imperfecta and treated with zoledronate, after which she developed atypical femoral fractures. After switching to teriparatide therapy, her bone mineral density improved significantly. This case underscores that persistently low alkaline phosphatase with fragility or atypical fractures should prompt evaluation for hypophosphatasia and that antiresorptives (eg, bisphosphonates) may precipitate atypical fractures in this condition and should be avoided. Disease-specific therapy is enzyme replacement with asfotase alfa; anabolic therapy may improve bone mineral density in selected adults when asfotase alfa is unavailable.  \nKey Words: atypical fracture, bisphosphonate, adult hypophosphatasia, teriparatide, metabolic bone disorder  \nIntroduction  \nHypophosphatasia (HPP) is an extremely rare disease, with an estimated prevalence of 0.1 to 9 per 100 000 individuals [1] . Although it is more commonly observed in the pediatric population, there are few reports in medical literature about its presentation in adults, leading to uncertainties about the optimal treatment for this patient group. Teriparatide has been used off-label in adult patients with HPP. Limited reports indicate that this treatment appears to provide clinical and biochemical benefits, promoting gains in bone mineral density (BMD) and possibly aiding in fracture prevention [2]. We present the case of a middle-aged woman diagnosed with HPP in adulthood who, after 2 doses of zoledronic acid, experienced a fragility fracture and, following teriparatide therapy, showed significant improvement in trabecular BMD.  \nCase Presentation  \nA 37-year-old woman was referred to the endocrinology department due to pain in the right lower limb, tooth loss, and bone deformities in the femur and tibia, with abnormal curvatures. Several clinical tests were performed, including ionized calcium, 24-hour urinary calcium, phosphorus, total proteins, albumin, 25-hydroxyvitamin D, 1,25-dihydroxyvitamin D, deoxypyridinoline cross-links, intact PTH, creatine, and  \ncomplete blood count, all within normal ranges. Sequelae of rickets were diagnosed.  \nAdditionally, a dual-energy X-ray absorptiometry (DXA) scan revealed abnormal values in the lumbar spine and femoral neck (see Table 1) . Treatment with calcium and vitamin D supplements was initiated. The patient returned to the clinic at age 44, showing deterioration in DXA results. Due to radiographic findings suggestive of osteogenesis imperfecta, the diagnosis was reconsidered, and treatment with zoledronic acid was started. She received 2 doses of this medication: 1 in 2016 and another in 2018.  \nAt age 47, while standing, she experienced severe pain and the inability to walk. X-rays revealed 2 fragility fractures: a displaced transverse fracture in the left femur and an incomplete fracture in the right femur, with varus deformity.  \nGi","cbCaiclgqe4KX1kO","https://ap.wps.com/l/cbCaiclgqe4KX1kO","pdf",434510,"English","# Abstract\n# Introduction\n# Case Presentation\n# Diagnostic Assessment\n# Results\n## Longitudinal BMD values and T/Z-scores (DXA)","[{\"question\":\"What condition links low alkaline phosphatase and atypical fractures in this report?\",\"answer\":\"Hypophosphatasia (HPP). The case highlights persistently low alkaline phosphatase together with fragility or atypical fractures as a prompt for evaluating HPP.\"},{\"question\":\"How did bisphosphonate treatment relate to the fractures described?\",\"answer\":\"The patient developed fragility fractures while receiving bisphosphonate therapy (zoledronic acid). The report emphasizes that antiresorptives may precipitate atypical fractures in hypophosphatasia and should be avoided.\"},{\"question\":\"What therapy improved bone mineral density after the bisphosphonate-associated fractures?\",\"answer\":\"Teriparatide therapy. After switching to teriparatide (20 mcg subcutaneously daily), her BMD improved significantly, with DXA measurements summarized over time in Table 1.\"}]","Atypical Fracture From Bisphosphonate Use in Hypophosphatasia With Improved Bone Response to Teriparatide Therapy | PDF",1790704489]