Atypical femoral fractures after long-term bisphosphonates therapy: case report

Găleşanu, Corina; Buzdugă, Cătălin; Florescu, Alexandru; Zaharia, Valentin; Lisnic, Vitalie

doi:10.1530/boneabs.5.p386

Cited by 2 publications

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“…Nevertheless, long-term BP use is associated with multiple rare but severe adverse effects. More specifically, adverse effects include events of the gastrointestinal tract, such as abdominal pain, nausea, dyspepsia, vomiting and diarrhea [6], osteonecrosis of the jaw [7] and the maxillae [8], osteonecrosis of the external ear canal [9], hypocalcaemia [10,11], atypical femoral fractures [12] or subtrochanteric fractures [13], carpal tunnel syndrome [14], renal failure [15], oesophageal cancer [16], uveitis with macular edema [17], interface dermatitis [18], orbital inflammation [19] and non-contact allergenic drug-induced baboon syndrome [20]. Recently, according to Cibickova et al [21] experimental evidence has been provided that supports the idea of alendronate inhibiting cholesterol biosynthesis on the central nervous system.…”

Section: Open Accessmentioning

confidence: 99%

Histologic evaluation of femoral nerve demyelinating and axonal neuropathy in Wistar rats due to alendronate intake: a randomised study

Papamitsou

Papakoulas

Vasileios

et al. 2020

J of Biol Res-Thessaloniki

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Background: Bisphosphonates (BPs) are forceful inhibitors of osteoclast-mediated bone resorption. Long-term BP use is associated with multiple rare but severe adverse effects. The objective of this study was to investigate the possible effects of BPs in the structure of femoral nerve. Specimens from the femoral nerve of ten female 12-month old Wistar rats were used as control group and ten female 12-month old Wistar rats to which Alendronate (Fosamax, Merck) was administered per os for 13 weeks, were used as research group. Samples were observed under a Transmission Electron Microscope. G ratio measurements and statistical analysis with SPSS program were also performed. Results:The control group showed no major changes of the nerve's histologic image, with the exception of some spots of thickness of the nerve myelin sheath. The research group showed major morphological changes which varied from partial disorganization or thickening of the myelin to severe myelin thickening and axon strangulation. A statistically significant difference of the G ratio between the two groups was observed. Conclusions:The reported values (found in literature) for the morphologic measurements of the femoral nerve in Wistar rats are not complying with the ones we found in our study. There was a significant reduction of all three variables (the mean axon like diameter, the myelin thickness, G ratio) studied in the femoral nerve of the research group in contrast to control group. Our study demonstrates a possible correlation between alendronate administration and femoral nerve's function, nevertheless due to the small specimen further research is needed.

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Section: Open Accessmentioning

confidence: 99%

Histologic evaluation of femoral nerve demyelinating and axonal neuropathy in Wistar rats due to alendronate intake: a randomised study

Papamitsou

Papakoulas

Vasileios

et al. 2020

J of Biol Res-Thessaloniki

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“…On the other hand, the contralateral side should be assessed with imaging modalities for possible fractures [15]. However, Maheshwari et al [16] reported a case of a bisphosphonate-related atypical femoral fracture that was progressed despite the prophylactic cephalo- [18]. Interestingly, they denied that the benefits of bisphosphonate therapy outweigh the risks of AFF.…”

Section: Discussionmentioning

confidence: 99%

Fractures in Corticosteroid- and Bisphosphonate-treated Subjects With Longstanding Rheumatoid Arthritis

Moghtadaie¹,

Yazdi²,

Salimzadeh³

2021

crcp

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Background: Bisphosphonates are the most widely prescribed agents for the treatment of postmenopausal osteoporosis and other metabolic bone diseases. Atypical femoral fractures in bisphosphonate-treated patients have raised concerns regarding the long-term safety of this class of medications. Case Presentation: In this study, we report two patients suffering from fractures while receiving biphosphonates; a postmenopausal patient with rheumatoid arthritis and a history of long-term use of bisphosphonates and glucocorticoids presenting with multiple fractures as case one and another 52-year-old female patient diagnosed with Systemic Lupus Erythematosus (SLE) who suffered from a femoral shaft fracture without any history of prior traumatic incidents as case two. Conclusions: Considering the low risk for atypical femoral fractures, further careful screening for these types of fractures should be undertaken. In addition, in order to lower the rate of fractures in patients on long-term bisphosphonate therapy, assessment of patients’ contralateral side should be considered to prevent further fractures, especially in patients with prodromal pain.

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Atypical femoral fractures after long-term bisphosphonates therapy: case report

Cited by 2 publications

References 0 publications

Histologic evaluation of femoral nerve demyelinating and axonal neuropathy in Wistar rats due to alendronate intake: a randomised study

Histologic evaluation of femoral nerve demyelinating and axonal neuropathy in Wistar rats due to alendronate intake: a randomised study

Fractures in Corticosteroid- and Bisphosphonate-treated Subjects With Longstanding Rheumatoid Arthritis

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