The Outcome of Surgically Treated Femur Fractures Associated With Long-Term Bisphosphonate Use

Abstract

BP-related fractures are a recently described phenomenon. Despite initial osteoporosis, the DEXA scan may appear outside the osteoporotic range for the femoral neck in these patients. In addition, a much higher failure rate with intramedullary nailing requiring revision surgery may occur with these patients.

Healing Delayed But Generally Reliable After Bisphosphonate-associated Complete Femur Fractures Treated with IM Nails

“…Bisphosphonates have been proven to be highly effective as a treatment modality in patients with osteoporosis for the prevention of osteoporotic fractures [2,9,30]. Although the association between long-term bisphosphonate therapy and atypical femoral fractures is now accepted, the benefits of bisphosphonate therapy far outweigh the risks, and bisphosphonates continue to be a mainstay of treatment [1].…”

Timing of the initiation of bisphosphonates after surgery for fracture healing: a systematic review and meta-analysis of randomized controlled trials

“…Bisphosphonate (BP) therapy has become the most widely used method for the treatment of osteoporosis [1][2][3][4]. BP therapy inhibits osteoclast-mediated bone resorption to prevent bone loss and to improve bone strength [5][6][7][8].…”

Do atypical femoral fractures in patients with prolonged alendronate treatment heal?

“…[8] Atypical femoral fractures are usually atraumatic, may be bilateral, and may have delayed fracturehealing. [5,6,9] For this reason we discontinued alendronate treatment for our patients. They are now receiving only calcium and vitamin D supplementation.…”

“…[3,4] Also, recent reports have suggested that a potential complication may be delayed union after atypical femoral fracture stabilization in patients taking long-term bisphosphonate. [5,6] This article describes two patients on long-term alendronate therapy which were treated for atypical femoral fractures healed with surgical treatment plus calcium, vitamin D support, and alendronate discontinuation.…”