Is there a familial predisposition to bisphosphonate-induced atypical femoral fractures?

Okçu, Mehmet; Koçak, Fatmanur Aybala; Kaya, Samet Sancar; Tuncay, Figen

doi:10.5606/tftrd.2021.5248

Cited by 3 publications

(2 citation statements)

References 14 publications

(19 reference statements)

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“…The bilateral nature of the potential risk for an AFF may also indicate that a genetic component is involved. [28][29][30] This conclusion has been supported by recent reports indicating the potential involvement of missense mutations in the CYP1A1 gene [31] and the ENPP1 gene, [32] as well as osteomalacia causing genes. [32] The potential role of the indicated genes and others in AFF [33] has recently been reviewed by Serra-Vinardell et al [27] Interestingly, CYPA1 can be expressed by multiple cell types and is upregulated by hypoxia in human ECs.…”

Section: Characteristics Of Aff and Those Patients At Risksupporting

confidence: 64%

“…[ 27 ] Thus, any proposed mechanism must account for both the location and the time frame for development. The bilateral nature of the potential risk for an AFF may also indicate that a genetic component is involved. [ 28–30 ] This conclusion has been supported by recent reports indicating the potential involvement of missense mutations in the CYP1A1 gene [ 31 ] and the ENPP1 gene, [ 32 ] as well as osteomalacia causing genes. [ 32 ] The potential role of the indicated genes and others in AFF [ 33 ] has recently been reviewed by Serra‐Vinardell et al.…”

Section: Characteristics Of Aff and Those Patients At Riskmentioning

confidence: 55%

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Are secondary effects of bisphosphonates on the vascular system of bone contributing to increased risk for atypical femoral fractures in osteoporosis?

Hart

2023

BioEssays

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Osteoporosis (OP) is a bone disease which affects a number of post-menopausal females and puts many at risk for fractures. A large number of patients are taking bisphosphonates (BPs) to treat their OP and a rare complication is the development of atypical femoral fractures (AFF). No real explanations for the mechanisms underlying the basis for development of where AFF develop while on BPs has emerged.The present hypothesis will discuss the possibility that part of the risk for an AFF is a secondary effect of BPs on a subset of vascular cells in a genetically at-risk population, leading to localized deregulation of the endothelial cell (EC)-bone cell-matrix units in nutrient channels/canals of the femur and increased risk for AFF. This concept of targeting ECs is consistent with location of AFF in the femur, the bilateral risk for occurrence of AFF, and the requirement for long term exposure to the drugs.

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Section: Characteristics Of Aff and Those Patients At Risksupporting

confidence: 64%

Section: Characteristics Of Aff and Those Patients At Riskmentioning

confidence: 55%

Are secondary effects of bisphosphonates on the vascular system of bone contributing to increased risk for atypical femoral fractures in osteoporosis?

Hart

2023

BioEssays

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Alendronic-acid

2022

Reactions Weekly

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Bilateral Atypical Femoral Fractures after Bisphosphonate Treatment for Osteoporosis: A Literature Review

Hwang

Seo

Lim

et al. 2023

JCM

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Introduction: This literature review aimed to investigate the incidence, anatomical concerns, etiology, symptoms, diagnostic tools, management, and prognosis of bisphosphonate (BP)—associated bilateral atypical femoral fractures (AFFs). Methods: The PubMed, Cochrane Library, Web of Sciences, and CINAHL databases were searched up to 20 March 2022. All cases of bilateral AFFs were included, excluding those without any bisphosphonate treatment information and those in which the femoral fracture did not precisely fit into the diagnostic criteria for AFF. Results: We identified 43 patients with bilateral AFFs associated with BP use and conducted a comprehensive analysis. Among 43 patients, 29 (67%) had prodromal symptoms. Regarding the simultaneity of fracture, 21 cases (49%) occurred simultaneously, and 22 cases (51%) occurred sequentially. Alendronate was the most commonly used BP treatment (59%). Regardless of the medication type, BP intake duration was more than 5 years in 77%. The initial diagnosis was performed using X-rays in all cases. A total of 53% of patients had complete fractures, and all patients underwent surgical treatment. Among the remaining patients with incomplete fractures, 18% and 29% received surgical and medical treatments, respectively. After BP discontinuation, teriparatide was most commonly used (63%). Conclusions: The careful evaluation of relevant imaging findings in patients with thigh/groin pain allows the identification of early incomplete fractures and timely management. Since the rate of contralateral side fractures is also high, imaging studies should be performed on the asymptomatic contralateral side.

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Is there a familial predisposition to bisphosphonate-induced atypical femoral fractures?

Cited by 3 publications

References 14 publications

Are secondary effects of bisphosphonates on the vascular system of bone contributing to increased risk for atypical femoral fractures in osteoporosis?

Are secondary effects of bisphosphonates on the vascular system of bone contributing to increased risk for atypical femoral fractures in osteoporosis?

Alendronic-acid

Bilateral Atypical Femoral Fractures after Bisphosphonate Treatment for Osteoporosis: A Literature Review

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