Atypical Femoral Shaft Fractures Secondary to Long-term Bisphosphonate Therapy

Overview

Journal J Orthop

Specialty Orthopedics

Date 2017 Feb 17

PMID 28203048

Citations 3

Authors

Cemil Kayali

Taskin Altay

Firat Ozan

Serkan Sozkesen

Kamil Yamak

Affiliations

Soon will be listed here.

Abstract

Background: Bisphosphonates (BPs) are one of the most commonly used agents in the treatment of post-menopausal osteoporosis and other metabolic bone diseases.

Methods: Between 2010 and 2015, data of 22 osteoporotic women with femoral fractures due to low-energy trauma who received BPs previously were analysed.

Results: The mean duration of BP therapy was 7.6 years. The mean duration of union was 7.4 months. Five patients had non-union. Stress reaction was observed in the contralateral femur in 11 patients.

Conclusion: Radiographic studies should be performed on a regular basis to prevent atypical femoral fractures in patients on long-term BP therapy.

Citing Articles

Surgical Treatment for Bisphosphonate-related Atypical Femoral Fracture: A Systematic Review.

Ebrahimpour A, Sadighi M, Hoveidaei A, Chehrassan M, Minaei R, Vahedi H Arch Bone Jt Surg. 2021; 9(3):283-296.

PMID: 34239955 PMC: 8221447. DOI: 10.22038/abjs.2020.52698.2608.

Surgical Fixation of Atypical Femur Fractures in Bisphosphonate-treated Patients.

Rajput I, Kumar J, Siddiqui A, Jamil M, Soughat M, Ahmed M Cureus. 2019; 11(5):e4690.

PMID: 31333916 PMC: 6636699. DOI: 10.7759/cureus.4690.

Atypical femur fractures: a distinctive tract of adult hypophosphatasia.

Marini F, Brandi M Clin Cases Miner Bone Metab. 2018; 14(3):324-328.

PMID: 29354161 PMC: 5762223. DOI: 10.11138/ccmbm/2017.14.3.324.

References

Chan S, Rosenberg Z, Chan K, Capeci C . Subtrochanteric femoral fractures in patients receiving long-term alendronate therapy: imaging features. AJR Am J Roentgenol. 2010; 194(6):1581-6. DOI: 10.2214/AJR.09.3588. View

Shane E, Burr D, Abrahamsen B, Adler R, Brown T, Cheung A . Atypical subtrochanteric and diaphyseal femoral fractures: second report of a task force of the American Society for Bone and Mineral Research. J Bone Miner Res. 2013; 29(1):1-23. DOI: 10.1002/jbmr.1998. View

Armamento-Villareal R, Napoli N, Diemer K, Watkins M, Civitelli R, Teitelbaum S . Bone turnover in bone biopsies of patients with low-energy cortical fractures receiving bisphosphonates: a case series. Calcif Tissue Int. 2009; 85(1):37-44. DOI: 10.1007/s00223-009-9263-5. View

Somford M, Draijer F, Thomassen B, Chavassieux P, Boivin G, Papapoulos S . Bilateral fractures of the femur diaphysis in a patient with rheumatoid arthritis on long-term treatment with alendronate: clues to the mechanism of increased bone fragility. J Bone Miner Res. 2009; 24(10):1736-40. DOI: 10.1359/jbmr.090408. View

Allen M, Burr D . Changes in vertebral strength-density and energy absorption-density relationships following bisphosphonate treatment in beagle dogs. Osteoporos Int. 2007; 19(1):95-9. DOI: 10.1007/s00198-007-0451-8. View

Abrahamsen B, Eiken P, Eastell R . Subtrochanteric and diaphyseal femur fractures in patients treated with alendronate: a register-based national cohort study. J Bone Miner Res. 2008; 24(6):1095-102. DOI: 10.1359/jbmr.081247. View

Nieves J, Cosman F . Atypical subtrochanteric and femoral shaft fractures and possible association with bisphosphonates. Curr Osteoporos Rep. 2010; 8(1):34-9. DOI: 10.1007/s11914-010-0007-2. View

Lenart B, Neviaser A, Lyman S, Chang C, Edobor-Osula F, Steele B . Association of low-energy femoral fractures with prolonged bisphosphonate use: a case control study. Osteoporos Int. 2008; 20(8):1353-62. PMC: 4415520. DOI: 10.1007/s00198-008-0805-x. View

Yoon R, Hwang J, Beebe K . Long-term bisphosphonate usage and subtrochanteric insufficiency fractures: a cause for concern?. J Bone Joint Surg Br. 2011; 93(10):1289-95. DOI: 10.1302/0301-620X.93B10.26924. View

10.

Ott S . Long-term safety of bisphosphonates. J Clin Endocrinol Metab. 2005; 90(3):1897-9. DOI: 10.1210/jc.2005-0057. View

11.

Giusti A, Hamdy N, Papapoulos S . Atypical fractures of the femur and bisphosphonate therapy: A systematic review of case/case series studies. Bone. 2010; 47(2):169-80. DOI: 10.1016/j.bone.2010.05.019. View

12.

Li J, Mashiba T, Burr D . Bisphosphonate treatment suppresses not only stochastic remodeling but also the targeted repair of microdamage. Calcif Tissue Int. 2002; 69(5):281-6. DOI: 10.1007/s002230010036. View

13.

Whelan D, Bhandari M, McKee M, Guyatt G, Kreder H, Stephen D . Interobserver and intraobserver variation in the assessment of the healing of tibial fractures after intramedullary fixation. J Bone Joint Surg Br. 2002; 84(1):15-8. DOI: 10.1302/0301-620x.84b1.11347. View

14.

Chiang C, Zebaze R, Ghasem-Zadeh A, Iuliano-Burns S, Hardidge A, Seeman E . Teriparatide improves bone quality and healing of atypical femoral fractures associated with bisphosphonate therapy. Bone. 2012; 52(1):360-5. DOI: 10.1016/j.bone.2012.10.006. View

15.

Schilcher J, Aspenberg P . Incidence of stress fractures of the femoral shaft in women treated with bisphosphonate. Acta Orthop. 2009; 80(4):413-5. PMC: 2823197. DOI: 10.3109/17453670903139914. View

16.

Fleisch H . Bisphosphonates: mechanisms of action. Endocr Rev. 1998; 19(1):80-100. DOI: 10.1210/edrv.19.1.0325. View

17.

Kwek E, Goh S, Koh J, Png M, Howe T . An emerging pattern of subtrochanteric stress fractures: a long-term complication of alendronate therapy?. Injury. 2008; 39(2):224-31. DOI: 10.1016/j.injury.2007.08.036. View

18.

Wang K, Moaveni A, Dowrick A, Liew S . Alendronate-associated femoral insufficiency fractures and femoral stress reactions. J Orthop Surg (Hong Kong). 2011; 19(1):89-92. DOI: 10.1177/230949901101900121. View

19.

Capeci C, Tejwani N . Bilateral low-energy simultaneous or sequential femoral fractures in patients on long-term alendronate therapy. J Bone Joint Surg Am. 2009; 91(11):2556-61. DOI: 10.2106/JBJS.H.01774. View

20.

Egol K, Park J, Rosenberg Z, Peck V, Tejwani N . Healing delayed but generally reliable after bisphosphonate-associated complete femur fractures treated with IM nails. Clin Orthop Relat Res. 2013; 472(9):2728-34. PMC: 4117878. DOI: 10.1007/s11999-013-2963-1. View