Atypical fractures of the femur and bisphosphonate therapy

Giusti, Andrea; Hamdy, Neveen A. T.; Papapoulos, Socrates E.

doi:10.1016/j.bone.2010.05.019

Cited by 249 publications

(200 citation statements)

References 61 publications

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“…(11) Their results are generally comparable with this task force report with regard to age, mean duration of BP use, proportions with bilateral fractures, prodromal pain, comorbid conditions (ie, DM or RA), and concomitant use of estrogen, raloxifene, tamoxifen, and GCs. They also reported that patients with subtrochanteric versus femoral shaft fractures had a higher number of comorbid conditions, were more likely to have bilateral fractures, and were more often using PPIs.…”

Section: Atypical Subtrochanteric and Femoral Shaft Fractures: Clinicsupporting

confidence: 74%

“…(60) While this slow turnover makes the possibility of oversuppression of cortical bone remodeling in the femur unlikely, it is possible that prolonged reduction of remodeling could have an additive effect over time, especially if BPs continue to accumulate in the tissue. This may be relevant to atypical femoral fractures, where case series suggest a potentially significant effect of duration of treatment and a median treatment period of 5 years, according to Giusti and colleagues, (11) and 7 years, according to the current review.…”

Section: Insights Into the Pathogenesis Of Atypical Femoral Fracturesmentioning

confidence: 61%

“…(10)(11)(12)(13) A relatively large proportion of patients also has taken GCs in addition to BPs. GCs reduce osteoblast activity, increase osteoblast apoptosis, (14)(15)(16) and are also associated with osteonecrosis of the femoral head.…”

Section: Insights Into the Pathogenesis Of Atypical Femoral Fracturesmentioning

confidence: 99%

“…Patients who had used BPs for less than 5 years were more likely to be Asian and to have had a femoral shaft fracture prior to initiating BP therapy. (11) It is highly likely that case reports and case series of atypical femur fractures will continue to accumulate. In this regard, abstracts submitted to the 2010 Annual Meeting of the ASBMR (132)(133)(134)(135)(136) reported another 47 cases not included in this analysis.…”

Section: Atypical Subtrochanteric and Femoral Shaft Fractures: Clinicmentioning

confidence: 99%

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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

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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

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Section: Atypical Subtrochanteric and Femoral Shaft Fractures: Clinicsupporting

confidence: 74%

Section: Insights Into the Pathogenesis Of Atypical Femoral Fracturesmentioning

confidence: 61%

Section: Insights Into the Pathogenesis Of Atypical Femoral Fracturesmentioning

confidence: 99%

Section: Atypical Subtrochanteric and Femoral Shaft Fractures: Clinicmentioning

confidence: 99%

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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

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“…Several chronic diseases or medications were reported that are to be expected in the elderly. (24) We found a higher prevalence of dementia and obesity in patients with ST/FS than in those with hip fractures. Dementia is a risk factor for hip fractures, (25) as sufferers are prone to falls and to osteoporosis.…”

Section: Discussionmentioning

confidence: 56%

Subtrochanteric/femoral shaft Versus hip fractures: Incidences and identification of risk factors

Maravic¹,

Ostertag

Cohen‐Solal

2011

Journal of Bone and Mineral Research

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Subtrochanteric and femoral shaft (ST/FS) fractures are now considered to be fragility fractures in osteoporotic patients. Although rare, there is growing evidence of the burden that they constitute. Little is known about the change over time in incidence of ST/FS fractures. We assessed the incidence of ST/FS fractures and the associated risk factors from 2002 to 2009 compared with those of hip fractures. Data were obtained from the French National Database, which includes all hospital discharge codes from acute care facilities. Hospitalizations for primary surgical management of neck/trochanteric (hip) and ST/FS fractures in patients aged above 50 years were selected and described for different age groups. Incidences per million populations were calculated using the estimated French population adjusted for each year, age, and gender. We studied the change for each fracture site. The comorbidity factors related to these fractures were assessed in 2009 using multivariate logistic regression. From 2002 to 2009, the adjusted incidence of hip fractures decreased continuously from 4368 to 3662 in women ( p < 0.0001), and a mild increase from 1476 to 1384 in men ( p < 0.0001) after an initial decrease. In contrast, the incidence of ST/FS increased significantly in both genders (from 353 to 395 in women, from 146 to 159 in men).

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Atypical Fractures as a Potential Complication of Long-term Bisphosphonate Therapy

Sellmeyer¹

2010

JAMA

102

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Atypical fractures of the femur and bisphosphonate therapy

Cited by 249 publications

References 61 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

Subtrochanteric/femoral shaft Versus hip fractures: Incidences and identification of risk factors

Atypical Fractures as a Potential Complication of Long-term Bisphosphonate Therapy

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