Atraumatic Segmental Atypical Femur Fracture Secondary to Bisphosphonate Use: A Case Report

Overview

Journal J Clin Orthop Trauma

Specialty Orthopedics

Date 2017 Sep 8

PMID 28878545

Authors

Andrew J Lovy

Diana Patterson

Laura Skeeles

Richard Ghillani

David Joseph

Yangguan Wu

Rohit Hasija

Affiliations

Soon will be listed here.

Abstract

Atypical femur fractures as a result of long term bisphosphonate use are characterized by several unique radiographic features. We describe an atypical femur fracture treated by cephalomedullary nail with a previously undescribed segmental fracture pattern. Other than 1.5 years of bisphosphonate use the patient did not have any other risk factors known to cause atypical femur fractures. Judicious bisphosphonate use as well as increased awareness of the associated complications may help reduce the rate of bisphosphonate associated atypical femur fractures.

References

Gomberg S, Wustrack R, Napoli N, Arnaud C, Black D . Teriparatide, vitamin D, and calcium healed bilateral subtrochanteric stress fractures in a postmenopausal woman with a 13-year history of continuous alendronate therapy. J Clin Endocrinol Metab. 2011; 96(6):1627-32. DOI: 10.1210/jc.2010-2520. View

Teo B, Koh J, Goh S, Png M, Chua D, Howe T . Post-operative outcomes of atypical femoral subtrochanteric fracture in patients on bisphosphonate therapy. Bone Joint J. 2014; 96-B(5):658-64. DOI: 10.1302/0301-620X.96B5.32887. View

Tornetta 3rd P, Tiburzi D . Antegrade or retrograde reamed femoral nailing. A prospective, randomised trial. J Bone Joint Surg Br. 2000; 82(5):652-4. DOI: 10.1302/0301-620x.82b5.10038. View

Einhorn T, Bogdan Y, Tornetta 3rd P . Bisphosphonate-associated fractures of the femur: pathophysiology and treatment. J Orthop Trauma. 2013; 28(7):433-8. DOI: 10.1097/BOT.0000000000000023. View

Mashiba T, Hirano T, Turner C, Forwood M, JOHNSTON C, Burr D . Suppressed bone turnover by bisphosphonates increases microdamage accumulation and reduces some biomechanical properties in dog rib. J Bone Miner Res. 2000; 15(4):613-20. DOI: 10.1359/jbmr.2000.15.4.613. 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

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

Puah K, Tan M . Bisphosphonate-associated atypical fracture of the femur: Spontaneous healing with drug holiday and re-appearance after resumed drug therapy with bilateral simultaneous displaced fractures--a case report. Acta Orthop. 2011; 82(3):380-2. PMC: 3235321. DOI: 10.3109/17453674.2011.581267. View

10.

Aspenberg P, Genant H, Johansson T, Nino A, See K, Krohn K . Teriparatide for acceleration of fracture repair in humans: a prospective, randomized, double-blind study of 102 postmenopausal women with distal radial fractures. J Bone Miner Res. 2009; 25(2):404-14. DOI: 10.1359/jbmr.090731. View

11.

Neviaser A, Lane J, Lenart B, Edobor-Osula F, Lorich D . Low-energy femoral shaft fractures associated with alendronate use. J Orthop Trauma. 2008; 22(5):346-50. DOI: 10.1097/BOT.0b013e318172841c. View

12.

Wells G, Cranney A, Peterson J, Boucher M, Shea B, Robinson V . Risedronate for the primary and secondary prevention of osteoporotic fractures in postmenopausal women. Cochrane Database Syst Rev. 2008; (1):CD004523. DOI: 10.1002/14651858.CD004523.pub3. View

13.

Lovy A, Koehler S, Keswani A, Joseph D, Hasija R, Ghillani R . Atypical femur fracture during bisphosphonate drug holiday: a case series. Osteoporos Int. 2015; 26(6):1755-8. DOI: 10.1007/s00198-015-3063-8. View

14.

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

15.

Lenart B, Lorich D, Lane J . Atypical fractures of the femoral diaphysis in postmenopausal women taking alendronate. N Engl J Med. 2008; 358(12):1304-6. DOI: 10.1056/NEJMc0707493. View

16.

Visekruna M, Wilson D, McKiernan F . Severely suppressed bone turnover and atypical skeletal fragility. J Clin Endocrinol Metab. 2008; 93(8):2948-52. DOI: 10.1210/jc.2007-2803. View

17.

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

18.

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

19.

Wang Z, Bhattacharyya T . Trends in incidence of subtrochanteric fragility fractures and bisphosphonate use among the US elderly, 1996-2007. J Bone Miner Res. 2010; 26(3):553-60. PMC: 3179297. DOI: 10.1002/jbmr.233. View

20.

Black D, Cummings S, Karpf D, Cauley J, Thompson D, Nevitt M . Randomised trial of effect of alendronate on risk of fracture in women with existing vertebral fractures. Fracture Intervention Trial Research Group. Lancet. 1996; 348(9041):1535-41. DOI: 10.1016/s0140-6736(96)07088-2. View