Re: Absence of femoral cortical thickening in long-term bisphosphonate users: Implications for atypical femur fractures

Bone ◽  
2014 ◽  
Vol 68 ◽  
pp. 165
Author(s):  
Yueju Liu ◽  
Yingze Zhang
Keyword(s):  
Cortical Thickening ◽  
Femur Fractures ◽  
Atypical Femur Fractures

scholarly journals Long-term risks of bisphosphonate therapy

2014 ◽  
Vol 58 (5) ◽  
pp. 523-529 ◽  
Author(s):  
Nelson B. Watts
Keyword(s):  
Lower Risk ◽  
Observational Studies ◽  
Osteonecrosis Of The Jaw ◽  
Bisphosphonate Therapy ◽  
Safety Issues ◽  
Femur Fractures ◽  
Atypical Femur Fractures ◽  
Post Marketing ◽  
Risk Patients

The objective this study was to summarize long-term risks associated with bisphosphonate therapy. Search of relevant medical publications for data from clinical trials, trial extensions, observational studies and post-marketing reports. Trial extensions and modifications did not reveal significant long-term safety issues. Observational data suggest at least as many benefits as risks. Post-marketing reports of musculoskeletal pain, osteonecrosis of the jaw and atypical femur fractures have been widely circulated in the lay press. Most focus on long-terms risks has been on osteonecrosis of the jaw and atypical femur fractures which occur in patients who have not received bisphosphonate therapy but may be more frequent (though still uncommon) in patients who have been on treatment for 5 years or longer. Lower-risk patients may be able to stop treatment after 3-5 years for a “drug holiday,” which mitigates these long-term risks; for higher risk patients, therapy through 6-10 years appears to be advisable and offers more benefits than risks.

scholarly journals Atypical femur fractures: current understanding and approach to management

2020 ◽  
Vol 12 ◽  
pp. 1759720X2091698
Author(s):  
Lianne Tile ◽  
Angela M. Cheung
Keyword(s):  
Medical Therapy ◽  
Clinical Decision Making ◽  
Osteoporotic Fractures ◽  
Osteoporosis Treatment ◽  
Clinical Decision ◽  
Current Understanding ◽  
Rare Type ◽  
Femur Fractures ◽  
Atypical Femur Fractures

Osteoporosis and resulting osteoporotic fractures are responsible for significant morbidity, excess mortality, and health care costs in the developed world. Medical therapy for osteoporosis has been shown in multiple randomized controlled trials to reduce the risk of vertebral and non-vertebral fractures and hip fractures, and in some studies bisphosphonate medications have been associated with improved survival. Although the overall benefit to risk ratio of osteoporosis medications remains favorable, there have been concerns raised about the long-term safety of these treatments. Atypical femur fracture, which is a rare type of fracture that has been associated with the long-term use of potent antiresorptive bone medications, is a potentially devastating consequence of osteoporosis treatment. This paper reviews our current understanding of atypical femur fractures, their relationship to antiresorptive osteoporosis medications, and proposed strategies for management, in order to inform clinical decision making about the optimal use and duration of medical therapy for the treatment of patients with osteoporosis or at high risk for osteoporotic fractures.

scholarly journals Long-Term Alendronate Use Not without Consequences?

2009 ◽  
Vol 2009 ◽  
pp. 1-6 ◽  
Author(s):  
M. P. Somford ◽  
G. F. A. E. Geurts ◽  
J. W. A. M. den Teuling ◽  
B. J. W. Thomassen ◽  
W. F. Draijer
Keyword(s):  
Patient Group ◽  
Stress Fracture ◽  
Side Effect ◽  
Femur Fracture ◽  
Bisphosphonate Therapy ◽  
Lateral Side ◽  
Cortical Thickening ◽  
Specific Patient ◽  
Femur Fractures

A previously unknown side effect of biphosphonate use is emerging. In a specific patient group on long term biphosphonate therapy stress femur fractures seem to occur. The typical presentation consists of prodromal pain in the affected leg and/or a discrete cortical thickening on the lateral side of the femur in conventional radiological examination or the presentation with a spontaneous transverse subtrochanteric femur with typical features. We present three cases of this stress fracture in patients on bisphosphonate therapy. One of these patients suffered a bilateral femur fracture of the same type. In our opinion, in patients on bisphosphonate therapy who present with a spontaneous femur fracture, seizing therapy is advisable. In bilateral cases preventive nailing should be considered.

Atypical Femur Fracture in the Setting of Long-Term Bisphosphonate use for Osteogenesis Imperfecta: A Case Report

2022 ◽  
Vol 5 (1) ◽  
pp. 01-09
Author(s):  
Parker J. Prusick ◽  
Steven D. Jones Jr. ◽  
Jesse Roberts ◽  
Nathan Donaldson
Keyword(s):  
Case Report ◽  
Osteogenesis Imperfecta ◽  
Femur Fracture ◽  
Mineral Density ◽  
Mineral Research ◽  
Femur Fractures ◽  
Atypical Femur Fractures ◽  
Impending Fracture

Bisphosphonate (BP) therapy for moderate to severe osteogenesis imperfecta (OI) has become a mainstay of treatment in the last three decades. Given the significant improvements in bone mineral density and theoretical reductions in fracture risk, many patients are treated with bisphosphonates for prolonged periods of time. There currently lacks consensus in the optimal duration of BP therapy for patients with OI, and patients are often treated on a case-by-case basis. Long-term BP therapy has been associated with atypical femur fractures in adult patients treated for osteoporosis. The American Society for Bone and Mineral Research concluded that the median duration of BP therapy in patients with atypical femur fractures was 7 years. The role of long-term BP therapy in OI patients with atypical femur fractures remains unclear. Here, a case report is presented of an adolescent patient with type V OI that sustained a subtrochanteric femur fracture with features of an atypical pattern following treatment with intravenous pamidronate for 10.5 years. At the time of injury, the contralateral femur was also found to have atypical features suggestive of an impending fracture. The completed fracture was treated with closed reduction and cephalomedullary nail fixation. The impending fracture was prophylactically stabilized using the same technique. Prior to the injury, limb-length radiographs obtained to evaluate lower extremity alignment demonstrated features of an impending fracture but went unnoticed. Further studies are needed to clarify the role of long-term BP therapy in patients with OI suffering from atypical femur fractures.

scholarly journals Association between alendronate and atypical femur fractures: a meta-analysis

2015 ◽  
Vol 4 (1) ◽  
pp. 58-64 ◽  
Author(s):  
Lu Liu ◽  
Chunyan Li ◽  
Peng Yang ◽  
Jian Zhu ◽  
Dongmei Gan ◽  
...  
Keyword(s):  
Meta Analysis ◽  
Cochrane Library ◽  
Short Term ◽  
Treatment Of Osteoporosis ◽  
Femur Fractures ◽  
Atypical Femur Fractures ◽  
The Subject ◽  
Mean Differences ◽  
The Relationship

Alendronate (ALN) is a commonly used drug for the treatment of osteoporosis. Atypical femur fractures (AFFs) have been associated with long-term use of ALN and have recently become the subject of considerable attention as ALN use increases. This meta-analysis aimed to determine the relationship between ALN and AFF. The Embase, PubMed, and Cochrane library databases were searched for relevant studies published before November 6, 2014. Studies clearly reporting the relationship between ALN and AFF were selected for our analysis. From these results, the relationship between ALN and AFF was analyzed. Weighted mean differences were calculated using a random-effects model. Five studies were included in this meta-analysis. The results revealed that the use of ALN will not increase the risk of AFF in short term (P>0.05), but there will be a risk of AFF (P<0.05) with long-term (>5 years) use of ALN. These findings indicate that long-term use of ALN is a risk factor for AFF and that more attention should be paid to the clinical applications of ALN.

Long-term radiographic follow-up of bisphosphonate-associated atypical femur fractures

2016 ◽  
Vol 45 (5) ◽  
pp. 627-633 ◽  
Author(s):  
Jennifer L. Favinger ◽  
Daniel Hippe ◽  
Alice S. Ha
Keyword(s):  
Femur Fractures ◽  
Atypical Femur Fractures
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