Stress fracture of the bowed femoral shaft is another cause of atypical femoral fracture in elderly Japanese: a case series

Oh, Yoto; Wakabayashi, Y.; Kurosa, Yoshiro; Ishizuki, Masafumi; Okawa, Atsushi

doi:10.1007/s00776-014-0572-9

Cited by 63 publications

(49 citation statements)

References 25 publications

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“…Femoral bowing is one of the causes of atypical femoral diaphyseal fracture as well as long-term use of bisphosphonate. [12] Since she took risedronate for just 1year, it is difficult to estimate the effect of bisphosphonate in this case. The task force team report of the American Society of Bone and Mineral Research excluded the metabolic bone disease such as hyperparathyroidism and Paget's disease in the definition of AFF.…”

Section: Discussionmentioning

confidence: 99%

Paget's Disease: Skeletal Manifestations and Effect of Bisphosphonates

2017

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BackgroundPaget's disease of bone leads to change in the shape and size of the bone and results in reduced bone strength, leading to the complications of deformity, arthritis, and fracture. Due to unknown reasons, Paget's disease is rare in Asian descendants. We report the cases of Paget's disease who visited our institute for 15 years and reviewed the literatures.MethodsWe retrospectively reviewed the medical records and radiograms of 8 patients (6 female and 2 male) who were diagnosed as Paget's disease of bone. Diagnosis was confirmed by typical radiological feature in the involved skeletons and/or pathologic findings.ResultsPelvis, skull and spine were three most frequently involved bones. All involved bones in our cases showed changes in shape and trabecular pattern which resulted in bowing of lower extremity, secondary osteoarthritis, compression fracture of spine and enlargement of skull. Mean follow time was 4.71 years and all patient were treated bisphosphonate (BP). Use of BP controlled the level of serum alkaline phosphatase level effectively.ConclusionsWe have reviewed eight patients who were previously diagnosed as Paget's disease of bone in our institute. We could identify typical radiologic and clinical findings such as bowing deformity of long bone, secondary osteoarthritis, compression fracture and osteomyelitis of mandible that deteriorated the quality of their living.

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Section: Discussionmentioning

confidence: 99%

Paget's Disease: Skeletal Manifestations and Effect of Bisphosphonates

2017

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“…After the concept of atypical femoral fractures became known widely, in Asian countries especially, stress fractures associated with bowing deformity have been confused with atypical fractures associated with long-term use of BPs [16]. According to ASMBR 2013, stress fractures, which occur without a history of BPs medication may also be classified as atypical femoral fractures.…”

Section: Discussionmentioning

confidence: 99%

“…Some authors suggested that stress concentration on the diaphysis due to anteriorly and laterally bent shape of the femur may be an important causative factor of the atypical fracture [8, 16, 22]. Mechanical alterations due to the bowing of the femur increase the bending force on the anterior and lateral cortex.…”

Section: Discussionmentioning

confidence: 99%

“…ASBMR Task Force 2013 revised case definition of atypical femoral fractures, deleting the clause associated with the use of pharmaceutical agents such as BPs, glucocorticoids, and proton pump inhibitors [15]. Under this definition, stress fractures which have been well recognized to be caused by bowing deformity may also be classified as atypical femoral fractures [16]. …”

Section: Introductionmentioning

confidence: 99%

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Atypical Complete Femoral Fractures Associated with Bisphosphonate Use or Not Associated with Bisphosphonate Use: Is There a Difference?

Kim

Park

Moon

et al. 2016

BioMed Research International

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The purpose of this study is to compare clinical characteristics and surgical outcome of atypical complete femoral fractures associated with bisphosphonates (BPs) use and those of fractures not associated with BPs use. Seventy-six consecutive patients (81 fractures) who had been operatively treated for a complete atypical femoral fracture were recruited. Of the 81 fractures, 73 occurred after BPs medication of at least 3 years (BP group) while 8 occurred without a history of BP medication (non-BP group). There were no differences in demographic data and fracture- and surgery-associated factors between the two groups. Of 76 patients (81 fractures), 54 (66.7%) fractures showed bony union within 6 months after the index surgery and 23 (28.4%) showed delayed union at a mean of 11.2 months (range, 8–18 months). The remaining 4 fractures were not healed, even 18 months after the index surgery. There was no difference in healing rate between the BP group and the non-BP group. There were strong correlations between the fracture height and the degree of bowing regardless of BPs medication. All fractures except 1 occurred at the diaphyseal region of the femur when not associated with BP medication.

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“…New studies suggest that there may be geometric properties of the hip, such as a smaller femoral neck/shaft angle that may increase the risk for AFF [16]. In addition, women of Asian ethnic background appear to be at higher risk for AFF [17]. Thus, a simple X-ray of the hip and determination of ethnicity may help differentiate some patients at increased risk for a serious side effect.…”

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confidence: 90%

Duration of anti-resorptive therapy for osteoporosis

Adler

2015

Endocrine

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Osteoporotic fractures are common, and available medications reduce fracture risk by up to half. However, because the most commonly used drugs, bisphosphonates, have side effects that may be related to duration of therapy and because long-term efficacy has not been established, the optimal length of treatment has not been determined. Based on two long-term studies and extensive clinical experience, a plan is provided to treat patients at risk for 5 years with re-assessment every 2 years thereafter. Assessment tools are limited, but for each individual, the potential risks and benefits of continuing, discontinuing, re-instituting, or changing therapy can be estimated.

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Stress fracture of the bowed femoral shaft is another cause of atypical femoral fracture in elderly Japanese: a case series

Cited by 63 publications

References 25 publications

Paget's Disease: Skeletal Manifestations and Effect of Bisphosphonates

Paget's Disease: Skeletal Manifestations and Effect of Bisphosphonates

Atypical Complete Femoral Fractures Associated with Bisphosphonate Use or Not Associated with Bisphosphonate Use: Is There a Difference?

Duration of anti-resorptive therapy for osteoporosis

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