Atypical femur fractures associated with bisphosphonates treatment: Retrospective single-center study

Aim: Osteoporosis is a very common condition caused by an imbalance between bone production and resorption. The first-linetreatment of osteoporosis and the most commonly prescribed medication group is bisphosphonates. In recent years, severalresearches have reported that atypical femur fractures are seen following long term bisphosphonate usage. However, time of usageis not clearly defined yet. Our purpose of this study was to unveil the correlation between long term bisphosphonate usage andatypical femur fractures.Material and Methods: Patients with a history of bisphosphonates treatment with atypical femur fracture were retrospectivelyanalyzed. The collected data included patient demographics, the presence of trauma or history of the fracture, concomitant medicaldiagnoses, and history of bisphosphonates usage, type of bisphosphonates used, concomitant fractures, and other complicationsrelated to atypical femur fractures, mortalities.Results: Twenty-two patients were included. All patients were female, and the mean age was 79.36±8.71 (mean ± SD) years. Sixteenpatients were taking alendronate for an average of 6.81±2.74 (mean ± SD) years while six patients were taking ibandronate sustainedatypical femur fractures in a shorter time average of 4.66±1.49 (mean ±SD) years. Atypical femur fractures are started to be diagnosedafter 3 years of usage with having peak numbers in forth year.Conclusion: Our study supports correlation between long term bisphosphonates usage and atypical femur fractures as reported inseveral studies. In the use of long-term bisphosphonates more than 3 years, care should be taken for atypical femur fractures, withinvestigating prodromal symptoms and performing radiological imaging.

PDF

___

1. Borrelli J, Jr, Lane J, Bukata S, et al. Atypical femur fractures. J Orthop Trauma 2014;28:36-42.
2. Mashiba T, Hirano T, Turner CH, et al. Suppressed bone turnover by bisphosphonates increases microdamage accumulation and reduces some biomechanical properties in dog rib. J Bone Miner Res 2000;15:613- 20.
3. Isaacs JD, Shidiak L, Harris IA, Szomor ZL. Femoral insufficiency fractures associated with prolonged bisphosphonate therapy. Clin Orthop Relat Res 2010; 468:3384-92.
4. Schilcher J, Michaelsson K, Aspenberg P. Bisphosphonate use and atypical fractures of the femoral shaft. N Engl J Med 2011;364:1728-37.
5. Saita Y, Ishijima M, Kaneko K. Atypical femoral fractures and bisphosphonate use: current evidence and clinical implications. Ther Adv Chronic Dis 2015;6:185-93.
6. Odvina CV, Zerwekh JE, Rao DS, et al. Severely suppressed bone turnover: a potential complication of alendronate therapy. J Clin Endocrinol Metab 2005;90:1294-301.
7. Shane E, Burr D, Abrahamsen B, et al. Atypical subtrochanteric and diaphyseal femoral fractures: second report of a task force of the American Society for Bone and Mineral Research. J Bone Miner Res 2014;29:1-23.
8. Bogdan Y, Tornetta P, 3rd, Einhorn TA, et al. Healing Time and Complications in Operatively Treated Atypical Femur Fractures Associated With Bisphosphonate Use: A Multicenter Retrospective Cohort. J Orthop Trauma 2016;30:177-81.
9. Fijewski G, Szostakowski B, Gorski R, et al. Atypical Fractures of the Femur Associated with Chronic Treatment with Bisphosphonates. Ortop Traumatol Rehabil 2016;18:239-49.
10. Lee YK, Ahn S, Kim KM, et al. Incidence Rate of Atypical Femoral Fracture after Bisphosphonates Treatment in Korea. J Korean Med Sci 2018; 33:e38.
11. Toro G, Ojeda-Thies C, Calabro G, et al. Management of atypical femoral fracture: a scoping review and comprehensive algorithm. BMC Musculoskelet Disord 2016;17:227.
12. Giusti A, Hamdy NA, Papapoulos SE. Atypical fractures of the femur and bisphosphonate therapy: A systematic review of case/case series studies. Bone 2010;47:169-80.
13. Dokmeci M, Kalender A, Sevimli R, Korkmaz M, Bilal O. The Effect of Ibandronate on Fracture Healing in Rat Tibia Model. SM J Orthop 2016;2:1041.
14. Banffy MB, Vrahas MS, Ready JE, et al. Nonoperative versus prophylactic treatment of bisphosphonateassociated femoral stress fractures. Clin Orthop Relat Res 2011;469:2028-34.
15. Favinger JL, Hippe D, Ha AS. Long-term radiographic follow-up of bisphosphonate-associated atypical femur fractures. Skeletal Radiol 2016;45:627-33.
16. Goh SK, Yang KY, Koh JS, et al. Subtrochanteric insufficiency fractures in patients on alendronate therapy: a caution. J Bone Joint Surg Br 2007;89:349- 53.
17. Murphy CG, O’Flanagan S, Keogh P, et al. Subtrochanteric stress fractures in patients on oral bisphosphonate therapy: an emerging problem. Acta Orthop Belg 2011;77:632-7.
18. Miyakoshi N, Aizawa T, Sasaki S, et al. Healing of bisphosphonate-associated atypical femoral fractures in patients with osteoporosis: a comparison between treatment with and without teriparatide. J Bone Miner Metab 2015;33:553-9.