Case Report
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Jun 18, 2019; 10(6): 247-254
Published online Jun 18, 2019. doi: 10.5312/wjo.v10.i6.247
Bilateral sequential femoral neck stress fractures in young adult with HIV infection on antiretroviral therapy: A case report
Saisunder Shashank Chaganty, Deeptiman James
Saisunder Shashank Chaganty, Faculty of Medicine and Dentistry, University of Plymouth, Plymouth PL6 8BU, United Kingdom
Deeptiman James, Assistant Professor, Department of Orthopedics, Christian Medical College, Vellore, Vellore 632004, Tamil Nadu, India
Author contributions: Chaganty SS and James D contributed equally to this work; Deeptiman J designed methodology and provided patient data; Chaganty SS performed literature review; and Chaganty SS and Deeptiman J analysed literature and wrote the manuscript.
Informed consent statement: The patient provided informed written consent.
Conflict-of-interest statement: All authors have no conflicts of interest to report.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Saisunder Shashank Chaganty, MBBS, Medical Student, Faculty of Medicine and Dentistry, University of Plymouth, John Bull Building, 16 Research Way, Plymouth Science Park, Plymouth PL6 8BU, United Kingdom. saisunder.chaganty@students.plymouth.ac.uk
Telephone: +0044-7952831648
Received: January 25, 2019
Peer-review started: January 25, 2019
First decision: March 14, 2019
Revised: April 13, 2019
Accepted: May 21, 2019
Article in press: May 23, 2019
Published online: June 18, 2019
Processing time: 143 Days and 5.5 Hours
Abstract
BACKGROUND

Femoral neck stress fractures are rarely encountered among young adults and are often associated with either repetitive excessive loading or underlying bone pathology. Preliminary research has indicated human immunodeficiency virus (HIV)/antiretroviral therapy (ART) as predisposing agents to osteopenia and osteoporosis related complications. We report a case of HIV/ART induced insufficiency fracture in a resource limited setting in Central India. Our aim is to increase awareness and promote screening of HIV/ART related osteopenia and osteoporosis in order to prevent catastrophic orthopaedic complications.

CASE SUMMARY

A 35-year-old HIV positive male presented with a stress fracture of left femoral neck. The patient was on ART and reported no comorbidities. He went on to be successfully managed surgically. However, during work-up osteopenia of the contralateral proximal femur was recognised using Singh’s Index. Six months post-op the patient presented with right-sided femoral - neck stress fracture. At this stage the patient was nonconcordant with ART and denied surgical fixation.

CONCLUSION

In the absence of co-morbidities, several mechanisms of HIV/antiretroviral therapy may have played a role in predisposing our patient towards such a presentation. We recommend routine screening all HIV-infected patients for osteopenia, especially in younger individuals. In low resource settings and district hospitals, pelvis radiograph & Singh’s index can be used for screening.

Keywords: Bilateral femoral neck stress fracture; Human immunodeficiency virus-antiretroviral therapy related osteopenia; Osteoporosis in resource limited setting; Human immunodeficiency virus related fragility fractures

Core tip: Stress fractures of the femoral neck among young adults are extremely rare. They usually result from either fatigue or predisposing conditions that give rise to weakened bones. We present a case of bilateral sequential femoral neck stress fractures in a young adult with human immunodeficiency virus (HIV) infection on antiretroviral therapy (ART) in the absence of comorbidities. Several mechanisms of HIV/ART induced osteopenia and osteoporosis are indicated to have played a role in predisposing our case towards such a presentation. Our case study adds to the paucity of evidence exploring the association between HIV/ART and reduced bone mineral density. Our case highlights the need for screening and prophylactic treatment for osteopenia and osteoporosis coexisting with HIV infection and ART.