scholarly journals Prophylactic Nailing of Incomplete Atypical Femoral Fractures

2013 ◽  
Vol 2013 ◽  
pp. 1-4 ◽  
Author(s):  
Chang-Wug Oh ◽  
Jong-Keon Oh ◽  
Ki-Chul Park ◽  
Joon-Woo Kim ◽  
Yong-Cheol Yoon
Keyword(s):  
Femoral Fractures ◽  
Femoral Shaft ◽  
Bisphosphonate Therapy ◽  
Lateral Aspect ◽  
Atypical Femoral Fractures ◽  
Femoral Shaft Fractures ◽  
The Mean ◽  
Minimum Followup ◽  
Im Nailing

Introduction. Recent reports have described the occurrence of low-energy subtrochanteric and femoral shaft fractures associated with long-term bisphosphonate use. Although information regarding the surgical treatment of these atypical femoral fractures is increasing, it is unclear if the preventive operation is useful in incomplete fractures. This study examined the results of preventive intramedullary nailing for incomplete atypical femoral fractures.Material and Methods. A retrospective search was conducted for patients older than 50 years receiving bisphosphonate therapy, with incomplete, nondisplaced fractures in either the subtrochanteric or diaphyseal area of the femur. Seventeen patients with a total of 20 incomplete, non-displaced lesions were included. The mean duration of bisphosphonate use was 50.5 months. Eleven of the 17 (64.7%) patients had complete or incomplete fractures on the contralateral femur. All were treated with prophylactic fixation of an intramedullary (IM) nail. The minimum followup was 12 months.Results. All cases healed with a mean period of 14.3 weeks. Nineteen of the 20 cases healed with the dissolution of incomplete fractures of the lateral aspect. A complete fracture developed at the time of nailing in one patient, but it healed with callus bridging.Conclusion. IM nailing appears to be a reliable way of preventing the progress of incomplete atypical femoral fractures.

Medication-Induced Musculoskeletal Changes

2019 ◽  
pp. 322-326
Author(s):  
Winnie A. Mar
Keyword(s):  
Musculoskeletal System ◽  
Gold Standard ◽  
Imaging Modality ◽  
Femoral Fractures ◽  
Osteonecrosis Of The Jaw ◽  
Bisphosphonate Therapy ◽  
Atypical Femoral Fractures ◽  
Osteoblastic Activity ◽  
Induced Changes

Chapter 117 discusses common medication-induced changes of the musculoskeletal system. The effect of corticosteroids on the musculoskeletal system, including osteoporosis and osteonecrosis, is discussed. Corticosteroids decrease osteoblastic activity, stimulate bone resorption, and decrease intestinal absorption of calcium. Complications of bisphosphonate therapy such as atypical femoral fractures and osteonecrosis of the jaw are reviewed. Myopathies and tendon pathologies are briefly discussed, as well as bony changes potentially seen with long-term voriconazole treatment. For osteoporosis, DXA scan is the gold standard, whereas radiography is usually the first imaging modality performed in patients on voriconazole therapy who present with pain.

Risk factors for development of atypical femoral fractures in patients on long-term oral bisphosphonate therapy

Bone ◽  
2013 ◽  
Vol 56 (2) ◽  
pp. 426-431 ◽  
Author(s):  
Paola Franceschetti ◽  
Marta Bondanelli ◽  
Gaetano Caruso ◽  
Maria Rosaria Ambrosio ◽  
Vincenzo Lorusso ◽  
...  
Keyword(s):  
Risk Factors ◽  
Femoral Fractures ◽  
Bisphosphonate Therapy ◽  
Atypical Femoral Fractures ◽  
Oral Bisphosphonate

scholarly journals A Typical Metatarsal Fracture in a Patient on Long-Term Bisphosphonate Therapy

2019 ◽  
Vol 6 (4) ◽  
pp. 25-30
Author(s):  
Bijan Valiollahi ◽  
◽  
Mostafa Salehpour ◽  
Hamidreza Bashari ◽  
Shoeib Majdi ◽  
...  
Keyword(s):  
Rare Case ◽  
Femoral Shaft ◽  
Bisphosphonate Therapy ◽  
Mineral Density ◽  
Pathological Fractures ◽  
Femoral Shaft Fractures ◽  
T Score ◽  
Metatarsal Fracture ◽  
History Of

Bisphosphonates, more particularly alendronate, are a popular category of drugs in the treatment of postmenopausal and corticosteroid-induced osteoporosis. The present study contends that the long-term consumption of bisphosphonates causes not only subtrochanteric and femoral shaft fractures but also pathological fractures at other musculoskeletal sites. This report presents a rare case of alendronate-induced pathological metatarsal fracture in a 59-year-old female with a history of cuboid fracture following a twisting with abnormal Bone Mineral Density (BMD) (T score: −3.5; lumbar spine and −2.6; proximal femur).

Mid-term outcomes after the surgical treatment of atypical femoral fractures

2021 ◽  
Vol 103-B (11) ◽  
pp. 1648-1655
Author(s):  
Soo-Young Jeong ◽  
Kyu-Tae Hwang ◽  
Chang-Wug Oh ◽  
Joon-Woo Kim ◽  
Oog Jin Sohn ◽  
...  
Keyword(s):  
Plate Fixation ◽  
Femoral Fractures ◽  
Delayed Union ◽  
Fracture Site ◽  
High Grade ◽  
Atypical Femoral Fractures ◽  
Factors Affecting ◽  
The Mean

Aims The incidence of atypical femoral fractures (AFFs) continues to increase. However, there are currently few long-term studies on the complications of AFFs and factors affecting them. Therefore, we attempted to investigate the outcomes, complications, and risk factors for complication through mid-term follow-up of more than three years. Methods From January 2003 to January 2016, 305 patients who underwent surgery for AFFs at six hospitals were enrolled. After exclusion, a total of 147 patients were included with a mean age of 71.6 years (48 to 89) and 146 of whom were female. We retrospectively evaluated medical records, and reviewed radiographs to investigate the fracture site, femur bowing angle, presence of delayed union or nonunion, contralateral AFFs, and peri-implant fracture. A statistical analysis was performed to identify the significance of associated factors. Results The mean follow-up period was 70.2 months (36 to 191). There were 146 AFFs (99.3%) in female patients and the mean age was 71.6 years (48 to 89). The AFFs were located in the subtrochanter and shaft in 52 cases (35.4%) and 95 (64.6%), respectively. The preoperative mean anterior/lateral femoral bowing angles were 10.5° (SD 5.7°)/6.1° (SD 6.2°). The postoperative mean anterior/lateral bowing values were changed by 8.7° (SD 5.4°)/4.6° (SD 5.9°). Bisphosphonates had been used contemporarily in 115 AFFs (78.2%) for a mean of 52.4 months (1 to 204; SD 45.5) preoperatively. Nailing was performed in 133 AFFs (90.5%), and union was obtained at a mean of 23.6 weeks (7 to 85). Delayed union occurred in 41 (27.9%), and nonunion occurred in 13 (8.8%). Contralateral AFF occurred in 79 patients (53.7%), and the use of a bisphosphonate significantly influenced the occurrence of contralateral AFFs (p = 0.019). Peri-implant fractures occurred in a total of 13 patients (8.8%), and a significant increase was observed in cases with plating (p = 0.021) and high grade of postoperative anterolateral bowing (p = 0.044). Conclusion The use of a bisphosphonate was found to be a risk factor for contralateral AFF, and high-grade postoperative anterolateral bowing and plate fixation significantly increased the occurrence of peri-implant fractures. Long-term follow-up studies on the bilaterality of AFFs and peri-implant fractures are warranted. Cite this article: Bone Joint J 2021;103-B(11):1648–1655.

scholarly journals Beware of bone pain with bisphosphonates

2019 ◽  
Vol 12 (3) ◽  
pp. e225385 ◽  
Author(s):  
Venthan Jeyaratnam Mailoo ◽  
Vidya Srinivas ◽  
Jeremy Turner ◽  
William Duncan Fraser
Keyword(s):  
Vitamin D ◽  
Parathyroid Hormone ◽  
Hip Fractures ◽  
Bone Pain ◽  
Femoral Fractures ◽  
Bisphosphonate Therapy ◽  
Prodromal Symptoms ◽  
Atypical Femoral Fractures ◽  
X Ray

A 71-year-old woman who had been taking ibandronate for 10 years presented to an Endocrinology Department with persistent mid-thigh pain. Pelvic X-ray showed bilateral femoral cortical expansion, indicating impending atypical femoral fractures (AFFs). AFFs have been linked to long-term bisphosphonate therapy and have morbidity and mortality similar to that of hip fractures. Such fractures can be averted by regular reviews of bisphosphonate therapy and vigilance for prodromal symptoms. This patient’s bisphosphonate therapy was stopped, and fractures were avoided by treatment with vitamin D and parathyroid hormone.

scholarly journals Fraturas Atípicas do Fémur Associadas a Terapêutica Prolongada com Bisfosfonatos

2013 ◽  
Vol 26 (6) ◽  
pp. 746
Author(s):  
Francisco Flores Santos ◽  
José Pinheiro da Silva ◽  
Paulo Felicíssimo
Keyword(s):  
Femoral Fracture ◽  
Scientific Evidence ◽  
Femoral Fractures ◽  
Osteoporotic Fractures ◽  
Femoral Shaft ◽  
Term Treatment ◽  
Atypical Femoral Fractures ◽  
Long Term Treatment

Introduction: Long-term treatment with bisphosphonates has been associated to atypical femoral fractures whose features are now clearly defined.Clinical Cases: We present two cases of female patients under bisphosphonate treatment for over 10 years who were admitted to our institution for subtrochanteric and femoral shaft fractures after low-energy trauma. They presented, respectively, a transverse and a short oblique femoral fracture, with thickening of the lateral cortex. They underwent surgical treatment obtaining good functional and imaging result.Discussion: These cases fulfill the established criteria for atypical femoral fracture, thereby illustrating a serious adverse event of long-term treatment with bisphosphonates. Such relationship has still not been clearly established by scientific evidence. However, its effectiveness in preventing osteoporotic fractures is well proven.Conclusion: The atypical femoral fractures are possibly a serious adverse effect of the long-term treatment with bisphosphonates. Scientific evidence still supports its use, however, the physician must be aware of these events and closely follow-up these patients.

scholarly journals Atypical femoral shaft fractures secondary to long-term bisphosphonate therapy

2017 ◽  
Vol 14 (2) ◽  
pp. 226-230 ◽  
Author(s):  
Cemil Kayali ◽  
Taskin Altay ◽  
Firat Ozan ◽  
Serkan Sozkesen ◽  
Kamil Yamak
Keyword(s):  
Femoral Shaft ◽  
Bisphosphonate Therapy ◽  
Femoral Shaft Fractures ◽  
Shaft Fractures
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