Atypical Fractures of the Femoral Diaphysis in Postmenopausal Women Taking Alendronate

Lenart, Brett A.; Lorich, Dean G.; Lane, Joseph M.

doi:10.1056/nejmc0707493

Cited by 457 publications

(305 citation statements)

References 2 publications

Supporting

Mentioning

282

Contrasting

Unclassified

Order By: Relevance

“…(107) Relatively few reports included bone turnover markers (BTMs). (13,109,(113)(114)(115)(116)122,123) When measured, however, bone resorption markers are usually within the normal premenopausal range (109,(114)(115)(116)123,124) and occasionally are elevated. (114,115,122) In only a minority of cases have BTMs been suppressed.…”

Section: Atypical Subtrochanteric and Femoral Shaft Fractures: Clinicmentioning

confidence: 99%

“…A femoral fracture must be ruled out. (10,12,93,100,110,115,124,159) Anteroposterior and lateral plain radiographs of the hip, including the full diaphysis of the femur, should be performed. If the radiograph is negative and the level of clinical suspicion is high, a technetium bone scan or MRI of the femur should be performed to detect a periosteal stress reaction.…”

Section: Key Research Questionsmentioning

confidence: 99%

“…Orthopedic management includes stabilizing the fracture and addressing the medical management (10,12,93,100,110,115,124,159) (see below). Since BPs inhibit osteoclastic remodeling, endochondral fracture repair is the preferred method of treatment.…”

Section: Key Research Questionsmentioning

confidence: 99%

“…Prophylactic reconstruction nail fixation is recommended for incomplete fractures accompanied by pain. (10,12,93,100,110,115,124,159) If the patient has minimal pain, a trial of conservative therapy, in which weight bearing is limited through the use of crutches or a walker, may be considered. However, if there is no symptomatic and radiographic improvement after 2 to 3 months of conservative therapy, prophylactic nail fixation should be strongly considered because these patients may progress to a complete fracture.…”

Section: Key Research Questionsmentioning

confidence: 99%

See 3 more Smart Citations

Atypical subtrochanteric and diaphyseal femoral fractures: Report of a task force of the american society for bone and mineral Research

Shane

Burr

Ebeling

et al. 2010

Journal of Bone and Mineral Research

988

679

View full text Add to dashboard Cite

Reports linking long-term use of bisphosphonates (BPs) with atypical fractures of the femur led the leadership of the American Society for Bone and Mineral Research (ASBMR) to appoint a task force to address key questions related to this problem. A multidisciplinary expert group reviewed pertinent published reports concerning atypical femur fractures, as well as preclinical studies that could provide insight into their pathogenesis. A case definition was developed so that subsequent studies report on the same condition. The task force defined major and minor features of complete and incomplete atypical femoral fractures and recommends that all major features, including their location in the subtrochanteric region and femoral shaft, transverse or short oblique orientation, minimal or no associated trauma, a medial spike when the fracture is complete, and absence of comminution, be present to designate a femoral fracture as atypical. Minor features include their association with cortical thickening, a periosteal reaction of the lateral cortex, prodromal pain, bilaterality, delayed healing, comorbid conditions, and concomitant drug exposures, including BPs, other antiresorptive agents, glucocorticoids, and proton pump inhibitors. Preclinical data evaluating the effects of BPs on collagen cross-linking and maturation, accumulation of microdamage and advanced glycation end products, mineralization, remodeling, vascularity, and angiogenesis lend biologic plausibility to a potential association with long-term BP use. Based on published and unpublished data and the widespread use of BPs, the incidence of atypical femoral fractures associated with BP therapy for osteoporosis appears to be very low, particularly compared with the number of vertebral, hip, and other fractures that are prevented by BPs. Moreover, a causal association between BPs and atypical fractures has not been established. However, recent observations suggest that the risk rises with increasing duration of exposure, and there is concern that lack of awareness and underreporting may mask the true incidence of the problem. Given the relative rarity of atypical femoral fractures, the task force recommends that specific diagnostic and procedural codes be created and that an international registry be established to facilitate studies of the clinical and genetic risk factors and optimal surgical and medical management of these fractures. Physicians and patients should be made aware of the possibility of atypical femoral fractures and of the potential for bilaterality through a change in labeling of BPs. Research directions should include development of animal models, increased surveillance, and additional epidemiologic and clinical data to establish the true incidence of and risk factors for this condition and to inform orthopedic and medical management. ß

show abstract

Section: Atypical Subtrochanteric and Femoral Shaft Fractures: Clinicmentioning

confidence: 99%

Section: Key Research Questionsmentioning

confidence: 99%

Section: Key Research Questionsmentioning

confidence: 99%

Section: Key Research Questionsmentioning

confidence: 99%

See 2 more Smart Citations

Atypical subtrochanteric and diaphyseal femoral fractures: Report of a task force of the american society for bone and mineral Research

Shane

Burr

Ebeling

et al. 2010

Journal of Bone and Mineral Research

988

679

View full text Add to dashboard Cite

show abstract

“…Further, although difficult to demonstrate, it is reasonable to assume, at some level of excess accumulation in humans, unrepaired microdamage will cause mechanical failure and inappropriate fracture. The recent reports of ''atypical'' fractures occurring during BP treatment [44] have focused attention on the possibility that antiresorptive therapy may have a downside. Perhaps, in suppressing the excessive stochastic remodeling in osteoporosis patients, their targeted remodeling can be oversuppressed by BP treatment, allowing accumulation of unrepaired microdamage and return of the fracture diathesis.…”

Section: Effects On Microdamage Repairmentioning

confidence: 99%

The Effect of Antiresorptives on Bone Quality

Recker

Armas

2011

Clinical Orthopaedics &Amp; Related Research

View full text Add to dashboard Cite

Background Currently, antiresorptive therapy in the treatment and prevention of osteoporosis includes bisphosphonates, estrogen replacement, selective estrogen receptor modulators (raloxifene), and denosumab (a human antibody that inactivates RANKL). The original paradigm driving the development of antiresorptive therapy was that inhibition of bone resorption would allow bone formation to continue and correct the defect. However, it is now clear increases in bone density account for little of the antifracture effect of these treatments. Questions/purposes We examined the antifracture benefit of antiresorptives deriving from bone quality changes. Methods We searched the archive of nearly 30,000 articles accumulated over more than 40 years in our research center library using a software program (Refman TM ). Approximately 250 publications were identified in locating the 69 cited here.

show abstract

Increasing Occurrence of Atypical Femoral Fractures Associated With Bisphosphonate Use

Meier¹,

Perneger²,

Stern³

et al. 2012

Arch Intern Med

192

148

View full text Add to dashboard Cite

show abstract

Atypical Fractures of the Femoral Diaphysis in Postmenopausal Women Taking Alendronate

Cited by 457 publications

References 2 publications

Atypical subtrochanteric and diaphyseal femoral fractures: Report of a task force of the american society for bone and mineral Research

Atypical subtrochanteric and diaphyseal femoral fractures: Report of a task force of the american society for bone and mineral Research

The Effect of Antiresorptives on Bone Quality

Increasing Occurrence of Atypical Femoral Fractures Associated With Bisphosphonate Use

Contact Info

Product

Resources

About