Atypical femoral fractures have been defined by the american society for bone and mineral research. Atypical femoral fractures in bisphosphonate treated patients reported over the last 7 years have raised concerns about longterm safety of antiresorptive therapy. Propagation of bisphosphonaterelated femoral stress. The first occurrences of bisphosphonate related affs. Bisphosphonates have been in use since the 1960s for the treatment of osteoporosis. Atypical femoral fractures aff are a rare type of femoral stress fracture recently described. Background studies show conflicting results regarding the possible excess risk of atypical fractures of the femoral shaft associated with bisphosphonate use. Bisphosphonate therapy minimizes bone loss and reduces fracture risk by up to. Bisphosphonateassociated atypical fractures that are not. Bisphosphonaterelated complete atypical subtrochanteric femoral fractures. Prophylactic intramedullary fixation for bisphosphonate. There was a 22% lower risk of hipfemur fractures during bisphosphonate current use.
Hip fractures are associated with an increased rate of death, substantial morbidity, enormous costs, and devastating effects on independence and quality of life. With the prevalence of osteoporosis expected to rise in the coming years, early recognition and management of. Frontal the stress insufficiency fractures are indicated by arrows. Pdf we present a case of a bisphosphonaterelated femur fracture in an elderly woman, who failed treatment with both cephalomedullary nail and. Atypical fractures and bisphosphonates american bone health. While the fracture pathogenesis is still unknown, there is evidence suggesting that longterm bisphosphonate use may stop bone metabolism, limiting the repair of microdamage and creating the risk of lowenergy fractures. Paradoxically, however, they have recently been linked to atypical fractures in the shaft of the femur. Recent case series have implicated bisphosphonate therapy, specifically alendronate, with lowenergy fractures of the subtrochanteric region of the femur. Bisphosphonates and atypical subtrochanteric fractures of the femur.
Bisphosphonates reduce the overall risk of fractures in patients with osteoporosis, even after cessation of use. These 2 cases are among the first reported failures of im fixation in preventing displacement of a bisphosphonate stress fracture. Six broad themes relating to the pathogenesis and management of bisphosphonaterelated affs are presented. Request pdf on apr 1, 20, jove graham and others published diaphyseal femur fractures associated with bisphosphonate use find, read and cite all the research you need on researchgate. Is it a simple stress fracture or bisphosphonaterelated.
The incidence of atypical femoral fractures per patientyears of treatment with a bisphosphonate for osteoporosis ranged from 0. Each reader was also shown examples typical of both types of fractures. Increasing occurrence of atypical femoral fractures. Cureus surgical fixation of atypical femur fractures in. Diaphyseal femur fractures associated with bisphosphonate. Correction oct 20, 2011 bisphosphonate use and atypical fractures of the femoral shaft. In recent years, atypical femoral fractures and osteonecrosis of the jaw have emerged as potential complications of longterm bisphosphonate therapy. The atypical fracture pattern occurs in the femur shaft and may be unilateral or bilateral. Incidence of atypical femur fractures associated with. However, in this case, the authors report this complication in a patient with shortterm use of this drug. However, paradoxically, they have been recently linked to fractures in. Correspondence jul 28, 2011 bisphosphonates and atypical femoral shaft fractures. Bilateral femur fractures associated with shortterm. Interpretation atypical periimplant fractures of the femur associated with bisphosphonate use may be a new entity.
In spite of its clinical benefits, the longterm use of bps has been linked to the occurrence of atypical femoral fractures affs. Bisphosphonaterelated subtrochanteric femoral fractures. Bisphosphonates bp are a commonly prescribed class of drugs for the prevention of osteoporosis related fractures. Travis watterson, bisphosphonaterelated atypical femur fractures and their radiographic features, the duration and safety of osteoporosis treatment, 10. Bisphosphonaterelated atypical femoral fracture article pdf available in the kaohsiung journal of medical sciences 296.
In large studies, women taking bisphosphonates for osteoporosis have had unusual fractures bisphosphonate fractures in the femur thigh bone in the shaft diaphysis or subtrochanteric. Numerous studies suggest a link between prolonged bisphosphonate therapy. Bisphosphonate use and atypical fractures of the femoral. This information is an update to the fda drug safety communication.
Femoral fractures following longterm bisphosphonate use. However, clinically, it is often confused whether is it a fatigue fracture because of. Bisphosphonates bp are a commonly prescribed class of drugs for the prevention of osteoporosisrelated fractures. Fracture outcomes related to persistence and compliance. Download bonesense pdf a recent 1 study has renewed worries among doctors and their patients about a rare but serious thigh fracture called atypical femur fracture or aff. Bisphosphonate use and the risk of subtrochanteric or. Pdf bisphosphonaterelated atypical femoral fracture. Objective to evaluate the outcomes of the surgical fixation of atypical femoral fractures in bisphosphonatetreated patients with an intramedullary device. Bisphosphonates and atypical femur fractures british. Bisphosphonates bps reduce the incidence of vertebral and nonvertebral fractures and suppress the loss of bone volume in patients with osteoporosis harris et al. Bilateral femur fractures have been reported in patients with longterm bisphosphonate use. Bisphosphonate therapy minimizes bone loss and reduces fracture risk by up to 50% in patients with osteoporosis, 1 but it is also associated with increased risks of osteonecrosis of the jaw and atypical. Braff bisphosphonaterelated atypical femoral fracture. The present authors have been following the development of these nonaff bisphosphonateassociated fractures since 2005 and have collected a large amount.
Background current evidence suggests that there is an association between bisphosphonate therapy and atypical femoral fractures, but the extent of this risk remains unclear methods between 1999 and. Stress lesions and atypical fractures may tend to develop over stress risers. Bisphosphonaterelated atypical femur fractures and their. Christian fang, jackie yeeman chau, siubon woo, takwing lau, kenny. Atypical femoral fracture radiology reference article. Atypical femoral fractures, also known as bisphosphonate related proximal femoral fractures, are an example of insufficiency fractures, although the direct causative link remains somewhat controversial 2. Pdf proximal femoral reconstruction for failed internal fixation of a. Spontaneous subtrochanteric femoral stress fracture. However, bp therapy is associated with adverse effects because bps inhibit osteoclast function and induce apoptosis, resulting in suppression of the bone turnover rate russell et al. Atypical femur fractures comprise only about of all subtrochanteric fractures, and, in. An increasing number of case reports describe women who develop fractures involving the subtrochanteric or shaft region of the femur in the setting of longterm bisphosphonate therapy. Atypical femoral fractures related to bisphosphonate therapy. Safety update for osteoporosis drugs, bisphosphonates, and.
Current estimates suggest that alendronate prevents 200 clinical fractures if 4000 women are treated over three years and will cause one femur fracture over the same course of time. Atypical femur fracture is a rare complication of bisphosphonate treatment, which is widely used for the prevention of osteoporotic fractures. Atypical femoral fractures related to bisphosphonate use. Bisphosphonates for treatment of osteoporosis expected beneits, potential harms, and drug holidays. Atypical femoral fractures have been suggested to be associated with patients receiving bisphosphonates for more than 3 to 5 years. Alendronate, a bisphosphonate, the most commonly used antiresorptive drug was. However, the clinical management of patients with bisphosphonaterelated fractures is more complex. Bisphosphonates substantially reduce fracture risk in women with postmenopausal osteoporosis, and treatment durations of up to 10 years further reduce risk of clinical vertebral fractures. Since many physicians including radiologists, are not aware of this entity, the incidence is likely underreported. Bisphosphonaterelated complete atypical subtrochanteric. There was no suggestion of a residual effect after stopping bisphosphonates. Recent case series have implicated bisphosphonate therapy, specifically alendronate, with lowenergy fractures of the subtrochanteric. The angle made by the fracture and lateral fe moral cortex is important in elucidating the etiology.
Bisphosphonates and atypical femoral fractures the journal for. Bisphosphonaterelated stress fractures radiology case. Radiographs of the contralateral femur should be obtained to assess for the presence of an. Bilateral bisphosphonaterelated hip fractures american journal. They reduce bone resorption by inhibiting the action of. Proximal femoral reconstruction for failed internal.
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