Atypical Femur Fractures Associated With Diphosphonate Use

Abstract

Osteoporosis-related fractures create a heavy economic and healthcare burden. Although diphosphonate medications have been successful at decreasing the risk of osteoporotic fragility fractures and have become staples in the treatment of osteoporosis, concerns have been raised about the association of diphosphonate therapy with spontaneous nonvertebral fractures. Diphosphonate fractures are characteristically transverse or slightly oblique in nature and occur in the lateral cortex, or tension side, of the subtrochanteric region of the femur where diffuse cortical thickening and fracture can be observed on radiographs. A multidisciplinary approach incorporating both medical and surgical teams should be used in the case of diphosphonate-associated fractures. Future medical and surgical developments that augment fracture fixation and counteract diphosphonate-associated osteoclast apoptosis may play a role in therapy. Although diphosphonate use has decreased the rate of osteoporosis-related fractures, increased awareness and association with atypical subtrochanteric fractures is an important concern for clinicians to keep in mind.

Imaging of Pelvic and Femoral Fixation Hardware: Normal Findings and Hardware Failure

“…Subtrochanteric fractures can occur secondary to trauma, but the subtrochanteric region is also a common site for pathologic fracture related to altered bone turnover with prolonged bisphosphonate use. 62,64,71,72 Imaging Imaging of all proximal femoral fractures should begin with AP and lateral radiographs of the affected hip and an AP pelvis radiograph. Most femoral neck and subtrochanteric fractures can be adequately visualized and classified on these views alone.…”

The management of fragility fractures of the hip: a quality assessment project

“…26 The most debated side effects of bisphosphonates are atypical femur fractures, osteonecrosis of the jaw and delayed or impaired fracture healing. 22,25 The rate of atypical femur fractures varies in the literature but the known fact is that the incidence shows an exponential increase with the increase in the number of years of continuous bisphosphonates treatment. 25 Osteoclastic activity remains inhibited for a few years after discontinuation of bisphosphonates use.…”

“…1,22 Sarcopaenia is being increasingly recognised as an independent risk factor for falls and fragility fractures. 23 Physiotherapists and dieticians work together to correct sarcopaenia and optimise physical performance of these patients for a better clinical outcome.…”

“…High-risk patients as determined by the applicable Fracture Risk Assessment Tool (FRAX index) are also eligible for treatment. 22,24 The FRAX tool combines patient's specific BMD and clinical risk factors such as age, gender, BMI, history of fragility fractures, history of maternal hip fracture and current smoking status to calculate a ten-year risk of hip or other osteoporosis-related fractures for the patient being assessed. This tool is country specific.…”

Bilateral Atypical Femur Fracture after Prolonged Use of Alendronate - A Case Report

“…The prevalence of female patients with femoral fractures -due to the increased incidence of osteoporosis is notable, especially those with atypical patterns, which are responsible for up to 95% of cases in this group of patients [7]. The most accepted ethiopathogeny is excessive suppression of osteoclastic activity and a consequent decrease in bone remodelling, leading to cortical hypermineralization, increased rigidity and a subsequent decrease in flexibility and resistance [2][3][4][5]. Radiographic findings are thickened cortical bone and complete transverse and short-oblique non-comminuted fractures comprising mostly the subtrochanteric region and the diaphysis [9].…”