Atypical femoral fracture due to chronic use of bisphosphonates: case report

Temponi, Eduardo Frois; Carvalho, Lucas Resende de; Costa, Luciane Rezende

doi:10.1016/j.rboe.2015.06.016

Cited by 2 publications

(2 citation statements)

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“…Although bisphosphonates are regarded as being effective treatment options for osteoporosis and other conditions as described above, there is a growing recognition of the rare occurrence of AFFs with prolonged bisphosphonate treatment. [8][9][10][11] These AFFs occur mainly (but not exclusively) in patients receiving long-term treatment for osteoporosis. 5,7,[8][9][10][11][12] As a result of this, patients should routinely be advised to seek medical advice and/or to report the occurrence of any new or evolving symptoms such as groin, hip or thigh pains while they are taking bisphosphonates.…”

Section: Diagnosing Affsmentioning

confidence: 99%

“…The latter in turn corresponding to areas or focal points that bear greatest compression strain during physical activities like running. 5,6,8,16 In 2010, in an attempt to standardise the case ascertainment of AFFs, the American society for bone and mineral research (ASBMR) task force described several criteria for use in case definition. 14 Over time, the criteria and the case definition of AFFs have undergone iterative reviews and was updated by the Task Force in 2013, producing a report published in 2014.…”

Section: Diagnosing Affsmentioning

confidence: 99%

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Nontraumatic bilateral atypical femoral fractures associated with long-term alendronate therapy

Ogundipe

2020

Int J Basic Clin Pharmacol

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Alendronate is a bisphosphonate commonly used in the treatment of post-menopausal and steroid-associated osteoporosis. Bisphosphonates have an evidence base for reducing the occurrence of typical osteoporotic fractures. However, there has been growing recognition of a correlation with the use of long-term therapy with bisphosphonates, and rare occurrence of atypical femoral fractures (AFFs). This report describes a 72-year-old caucasian woman presenting with evolving groin and thigh pains of two weeks duration. Plain X-rays noted features compatible with bilateral impending femoral subtrochanteric fractures. She had been taking oral alendronate 70mg weekly for ten consecutive years as treatment for osteoporosis. Based on the medication history, the absence of preceding trauma or a fall, and the presence of supportive radiological findings, the diagnosis was made of impending bilateral proximal femur fractures secondary to long-term bisphosphonate therapy. The alendronate was discontinued, and the patient managed with two planned successive surgeries involving the insertion of intertrochanteric antegrade nails (inter-TAN) to both femurs. Following a period of rehabilitation, she was successfully discharged home. Some pharmacokinetic and pharmacodynamic considerations of bisphosphonates are discussed. The write-up presents a brief literature review of AFFs. The index report is further reviewed in relation to the American society for bone and mineral research (ASBMR) task force’s recommended case definition of what constitutes AFFs. The discussion concludes with the application of two previously validated causality assessment systems (CAS). In this instance, both CAS indicated a ‘probable’ classification for the adverse drug reaction (ADR) to prolonged usage of oral alendronate.

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