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CC BY-NC-ND 4.0 · Revista Chilena de Ortopedia y Traumatología 2021; 62(01): 034-038
DOI: 10.1055/s-0041-1728734
Case Report | Caso Clínico

Proximal Femur Fracture (31-A3.2) Associated with the Use of Tenofovir by an HIV-positive Patient: Case Report

Article in several languages: español | English
Pia Franz Ruiz
1   Residente Ortopedia y Traumatología Universidad Austral de Chile, Valdivia, Chile
,
Marco Poblete Avilez
2   Equipo de Cadera y Pelvis, Hospital Base de Osorno, Los Lagos, Chile
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ErratumRevista Chilena de Ortopedia y Traumatología 2021; 62(01): e1-e3
DOI: 10.1055/s-0041-1733966

Abstract

We present the first case report of a human immunodeficiency virus (HIV)-positive adult patient with a fragility fracture of the proximal femur associated with antiretroviral therapy (ART) with tenofovir disoproxil fumarate (TDF) in Chile. Currently, patients diagnosed with HIV start ART early, resulting in more years of exposure to these drugs. The accumulated exposure time to TDF has been associated with a decreased bone mineral density and progressive renal failure, potentially leading to acquired Fanconi syndrome, osteomalacia, and an increased risk of fracture. We present a case of a 44-year-old, HIV-positive man assessed at the emergency room after a fall from standing height which resulted in a proximal femoral pathological fracture. Laboratory findings at admission revealed hypokalemia, hypocalcemia, hypophosphatemia, and hypovitaminosis D. Multidisciplinary management was performed, with TDF discontinuation, ART change, and supplementation with calcium and vitamin D. Closed reduction and fixation with a long cephalomedullary nail was successful, with early motor rehabilitation, functional recovery, and bone consolidation at 12 weeks. Musculoskeletal pain in HIV-positive patients on ART must raise the clinical suspicion of an adverse drug effect; the follow-up of these subjects must include serial monitoring of renal function and serum calcium and phosphorus levels. Screening and suspicion of such complications would enable an early intervention, improving the patients' condition and preventing pathological fractures.

Keywords

proximal femur fracture - antiretroviral agents - tenofovir - case report


Publication History

Received: 25 May 2020

Accepted: 21 January 2021

Article published online:
02 June 2021

© 2021. Sociedad Chilena de Ortopedia y Traumatologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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