Teriparatide treatment in a patient with atypical femoral fractures associated with long-term bisphosphonate therapy

2018 ◽  
Author(s):  
Nagihan Bestepe ◽  
Cevdet Aydin ◽  
Berna Evranos ◽  
Oya Topaloglu ◽  
Reyhan Ersoy ◽  
...  
Keyword(s):  
Femoral Fractures ◽  
Bisphosphonate Therapy ◽  
Atypical Femoral Fractures ◽  
Teriparatide Treatment

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 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.

Frequency of Incomplete Atypical Femoral Fractures in Asymptomatic Patients on Long-Term Bisphosphonate Therapy

2012 ◽  
Vol 198 (5) ◽  
pp. 1144-1151 ◽  
Author(s):  
Renata La Rocca Vieira ◽  
Zehava Sadka Rosenberg ◽  
Mary B. Allison ◽  
Shelly A. Im ◽  
James Babb ◽  
...  
Keyword(s):  
Femoral Fractures ◽  
Bisphosphonate Therapy ◽  
Atypical Femoral Fractures ◽  
Asymptomatic Patients

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.

Bilateral atypical femoral fractures after only 4-years of bisphosphonate therapy

2017 ◽  
Author(s):  
Edouard Mills ◽  
Pat Forbes ◽  
Michael Yee ◽  
Jeremy Cox ◽  
Alexander N Comninos
Keyword(s):  
Femoral Fractures ◽  
Bisphosphonate Therapy ◽  
Atypical Femoral Fractures

scholarly journals Duration of Bisphosphonate Drug Holidays in Osteoporosis Patients: A Narrative Review of the Evidence and Considerations for Decision-Making

2021 ◽  
Vol 10 (5) ◽  
pp. 1140
Author(s):  
Kaleen N. Hayes ◽  
Elizabeth M. Winter ◽  
Suzanne M. Cadarette ◽  
Andrea M. Burden
Keyword(s):  
Surrogate Marker ◽  
Femoral Fractures ◽  
Osteonecrosis Of The Jaw ◽  
Bisphosphonate Therapy ◽  
Narrative Review ◽  
Drug Holiday ◽  
Future Research ◽  
Mineral Density ◽  
First Line Therapy

Bisphosphonates are first-line therapy for osteoporosis, with alendronate, risedronate, and zoledronate as the main treatments used globally. After one year of therapy, bisphosphonates are retained in bone for extended periods with extended anti-fracture effects after discontinuation. Due to this continued fracture protection and the potential for rare adverse events associated with long-term use (atypical femoral fractures and osteonecrosis of the jaw), a drug holiday of two to three years is recommended for most patients after long-term bisphosphonate therapy. The recommendation for a drug holiday up to three years is derived primarily from extensions of pivotal trials with alendronate and zoledronate and select surrogate marker studies. However, certain factors may modify the duration of bisphosphonate effects on a drug holiday and warrant consideration when determining an appropriate time off-therapy. In this narrative review, we recall what is currently known about drug holidays and discuss what we believe to be the primary considerations and areas for future research regarding drug holiday duration: total bisphosphonate exposure, type of bisphosphonate used, bone mineral density and falls risk, and patient sex and body weight.

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