Research Article
Volume 11 Issue 7 - 2020
Bisphosphonate-Related Atypical Femoral Fracture: A Case Series
Mauricio Povoa Barbosa*, Alexandre Povoa Barbosa and Jader Joel Machado Junqueira
Orthobone Clinic - Orthopedic Surgery and Rehabilitation Center, Associacao Benifecente Siria HCor, Sao Paulo-SP, Brazil
*Corresponding Author: Mauricio Povoa Barbosa, Orthobone Clinic - Orthopedic Surgery and Rehabilitation Center, Associacao Benifecente Siria HCor, Sao Paulo-SP, Brazil.
Received: May 26, 2020; Published: June 20, 2020




Abstract

Aim: The present study reported a case series of atypical femoral fractures related to chronic bisphosphonate use and review the main topics of the disease.

Methods: Our case series were comprised to 8 patients, all female, mean age 74.7 ± 10.8 years (ranging from 57 to 89 years) and 11 femur fractures (3 patients had bilateral fractures) followed between January 2012 and December 2019. All patients were a preceding 6.1 ± 1.1 years history of bisphosphonate use for reported osteoporosis.

Results: Four patients presented with a displaced femoral fracture following minimal or no trauma and reported prodromal symptoms previously to fractures. The other four patients presented with incomplete femoral fracture on radiographs and reported the same symptoms. The average duration of prodromal symptoms was 7.3 ± 4.2 months (range 1 - 12 months). Bisphosphonate therapy was discontinued at the time of admission and administration of calcium and vitamin D were initiated to all patients with incomplete femur fracture and oriented to use crutches and partial weight bearing for three months. Patients complete fractures were conducted to surgery. Intramedullary nailing fixation was the surgical treatment of choice for patients with complete fracture plane (average healing fracture time: 9.1 months). None of the patients with conservative treatment healed in three months and all of them underwent prophylactically Surgery with Nail without distal fixation. For symptomatic incomplete fractures (average healing fracture time: 3.4 months). There were three cases of non-union in patients with complete fracture.

Conclusion: Atypical femoral fractures secondary to chronic use of bisphosphonates represents a spectrum of a disease with a slow evolution that can be insidious in onset and hard to diagnose. Early proactive treatment, with both medical and surgical interventions, may be the key to a good functional outcome.

Keywords: Bisphosphonates; Femoral Fracture; Osteoporosis; Spontaneous Fracture; Stress Fracture

References

  1. Cosman F., et al. “Clinician’s Guide to Prevention and Treatment of Osteoporosis”. Osteoporosis International 10 (2014): 2359-2381.
  2. Matcuk Jr GR., et al. “Stress fractures: pathophysiology, clinical presentation, imaging features, and treatment options”. Emergency Radiology 4 (2016): 365-375.
  3. Wang Z., et al. “Adherence to oral bisphosphonates and the risk of subtrochanteric and femoral shaft fractures among female medicare beneficiaries”. Osteoporosis International 8 (2014): 2109-2116.
  4. Isaacs JD., et al. “Femoral Insufficiency Fractures Associated with Prolonged Bisphosphonate Therapy”. Clinical Orthopaedics and Related Research 12 (2010): 3384-3392.
  5. Dell RM., et al. “Incidence of Atypical Nontraumatic Diaphyseal Fractures of the Femur”. Journal of Bone and Mineral Research 12 (2012): 2544-2550.
  6. Bronson WH., et al. “Atypical Femur Fractures: A Review”. Current Osteoporosis Reports 4 (2014): 446-453.
  7. Rheinboldt M., et al. “Atypical femoral fractures in association with bisphosphonate therapy: a case series”. Emergency Radiology 5 (2014): 557-562.
  8. Yang KH., et al. “Atypical Femoral Fracture: 2015 Position Statement of the Korean Society for Bone and Mineral Research”. Journal of Bone Metabolism 3 (2015): 87-91.
  9. Tyler W., et al. “Atypical Femur Fractures”. Clinics in Geriatric Medicine 2 (2014): 349-359.
  10. Shane E., et al. “Atypical Subtrochanteric and Diaphyseal Femoral Fractures: Second Report of a Task Force of the American Society for Bone and Mineral Research”. Journal of Bone and Mineral Research 1 (2014): 1-23.
  11. Chan SS., et al. “Subtrochanteric femoral fractures in patients receiving long-term alendronate therapy: imaging features”. American Journal of Roentgenology 6 (2010): 1581-1586.
  12. Schilcher J., et al. “Bisphosphonate use and atypical fractures of the femoral shaft”. New England Journal of Medicine 18 (2011): 1728-1737.
  13. Png MA., et al. “Bisphosphonate-related femoral periosteal stress reactions: scoring system based on radiographic and MRI findings”. American Journal of Roentgenology 4 (2012): 869-877.
  14. Donnelly E., et al. “Atypical femoral fractures: epidemiology, etiology, and patient management”. Current Opinion in Supportive and Palliative Care 3 (2012): 348-354.
  15. Carvalho NN., et al. “Atypical femoral fractures during prolonged use of bisphosphonates: short-term responses to strontium ranelate and teriparatide”. Journal of Clinical Endocrinology and Metabolism 9 (2011): 2675-2680.
  16. Watts NB. “Long-term risks of bisphosphonate therapy”. Arquivos Brasileiros de Endocrinologia and Metabologia 5 (2014): 523-529.
  17. Odvina CV., et al. “Severely Suppressed Bone Turnover: A Potential Complication of Alendronate Therapy”. Journal of Clinical Endocrinology and Metabolism 3 (2005): 1294-1301.
  18. Gedmintas L., et al. “Bisphosphonates and risk of subtrochanteric, femoral shaft, and atypical femur fracture: a systematic review and meta-analysis”. Journal of Bone and Mineral Research 8 (2013): 1729-1737.
  19. Nieves J and Cosman F. “Atypical subtrochanteric and femoral shaft fractures and possible association with bisphosphonates”. Current Osteoporosis Reports 1 (2010): 34-39.
Citation: Mauricio Povoa Barbosa., et al. “Bisphosphonate-Related Atypical Femoral Fracture: A Case Series”. EC Orthopaedics 11.7 (2020): 51-60.

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