Non-traumatic fracture neck bilateral femur in patients on Anti-retroviral therapy

Abstract

Introduction: Anti-Retroviral Therapy (ART) in HIV+ patients is known to cause decrease in bone mineral density (BMD). HIV infection and ART are included as risk factors for Osteoporosis and fragility fractures by National Osteoporosis Foundation in US. In our country, not many reports are available in this regard. The present article reports two HIV + patients of different age group, on ART for variable periods, who developed bilateral fracture neck femur without any trauma. The cases were managed suitably and are being reported due to its rarity and to stress the need of careful evaluation in HIV+ patients. Case Reports: Case 1: A HIV+ male patient of age 37 years on regular ART presented with pain in his both hips region for 1-year duration without any trauma or fall. X-ray pelvis with both hips showed transcervical minimally displaced fracture neck of both femora. The young patient was managed with multiple cancellous screw fixation in situ and is under regular follow up for 15 months. Case 2: A HIV+ male patient of 65 years under regular ART presented with the complaints of pain right hip with difficulty in walking for 1 month without any trauma. X-ray pelvis showed displaced fracture neck right femur and incomplete fracture of superior cortex of neck left femur. The patient was treated by Austin Moore prosthetic replacement of head femur on right side and observation for the left femur neck incomplete fracture. The case is under follow up and continuing ART also. Clinical Message: Spontaneous nontraumatic fracture should be suspected in HIV + patients having persistent localized pain in an area even without history of any trauma or classical features of fracture on physical examination. Radiological examination must be carried out before excluding fracture.