Audit of Atypical Femoral Fractures and a Description of Some of Their Features

Lian, Kevin; Trollip, Jacques; Sandhu, Supna; Moosavi, Mandana; Gill, Amninder; Kendler, David L.; Dian, Larry; Lentle, Brian C.

doi:10.1016/j.carj.2015.09.014

Cited by 9 publications

(6 citation statements)

References 39 publications

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“…However, it is the conjecture of the authors that some of these injuries were not recognised for what they were at the time of hospitalisation by orthopaedic surgeons or radiologists. This is the first study to our knowledge that has reported on whether or not AFF was diagnosed at the time of event by orthopaedic surgeon; however a previously published Canadian audit demonstrated that AFFs were not recognised by radiologists in all but one of 24 cases [14]. …”

Section: Discussionmentioning

confidence: 99%

Incidence and medical management of bisphosphonate-associated atypical femoral fractures in a major trauma centre: a retrospective observational study

Eisenstein

Kasavkar

Bhavsar

et al. 2017

BMC Musculoskelet Disord

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BackgroundAtypical femoral fractures (AFFs) are rare events associated with increased duration of bisphosphonate exposure. Recommended management of AFFs include cessation of bisphosphonates and imaging of the contralateral femur. The aims of this study were to identify the local incidence of AFFs in bisphosphonate users and to audit the medical management of AFFs against published recommendations.MethodsA retrospective analysis of the admissions database for a major trauma centre identified all femoral fractures (3150) in a five-year period (July 2009 to June 2014). Electronic health records and radiographs were reviewed using the 2013 American Society for Bone and Mineral Research (ASBMR) diagnostic criteria for AFF to establish the number of cases. To estimate incidence, the total number of bisphosphonate users was derived from primary care prescription and secondary care day-case records. Medical management of cases with AFF on bisphosphonates was audited against guidance from ASBMR and Medicines & Healthcare Products Regulatory Agency.Results10 out of 3150 femoral fractures met criteria for AFF; 7 of these patients had a history of exposure to bisphosphonates (6 oral, 1 intravenous). There were 19.1 AFFs per 100,000 years of bisphosphonate use in our region. Bisphosphonates were stopped and the contralateral femur imaged in only 2 of the 7 patients treated with bisphosphonates.ConclusionOur local incidence is in line with published figures; however, this is the first published evidence suggesting that medical management and identification of AFF may be suboptimal. Managing these patients remains challenging due to their rarity and possible lack of awareness.

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Section: Discussionmentioning

confidence: 99%

Incidence and medical management of bisphosphonate-associated atypical femoral fractures in a major trauma centre: a retrospective observational study

Eisenstein

Kasavkar

Bhavsar

et al. 2017

BMC Musculoskelet Disord

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“…Os bifosfonatos são o gold-standard no tratamento da osteoporose, com eficácia suportada pela evidência científica na prevenção das fraturas osteoporóticas. [1][2][3][4]7,[9][10][11] Desde 2005 têm surgido relatos de casos a sugerir uma relação entre o uso prolongado de bifosfonatos e a ocorrência de fraturas atípicas do fémur. 4-7,9,12 Figura 1.…”

Section: Comentáriounclassified

Uma fratura femoral atípica: relato de caso

Vaz

Sá

2023

RPMGF

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Introdução: A osteoporose é a doença metabólica mais comum do osso e os bifosfonatos são o seu tratamento de primeira linha. Apesar de eficazes a reduzir o risco de fraturas osteoporóticas têm surgido relatos de fraturas atípicas do fémur aparentemente relacionadas com a terapêutica prolongada com estes fármacos. Descrição do caso: Apresenta-se o caso de uma doente de 78 anos, diagnosticada há 21 anos com osteoporose. Ao diagnóstico foi medicada com ácido ibandrónico 150mg mensal. Em 2007 foi feito switch terapêutico para ácido alendrónico 70mg + colecalciferol 2800 U.I., semanal, o qual mantém desde então, perfazendo treze anos de terapêutica com esse fármaco. Foi transportada ao serviço de urgência de ortopedia na sequência de um trauma de baixa energia, do qual resultou uma fratura subtrocantéria do fémur esquerdo. Comentário: A relação causal entre o uso prolongado de bifosfonatos e as fraturas atípicas do fémur ainda não está estabelecida. Contudo, esta associação não deve ser ignorada, sendo essencial avaliar os riscos e benefícios antes de iniciar o tratamento, bem como promover uma vigilância ativa dos pacientes sob terapêutica prolongada com bifosfonatos. Os estudos reportam que mais de metade dos doentes que sofrem uma fratura atípica do fémur têm pródromos de dor na coxa ou na virilha, o que ocorreu no caso relatado, pelo que são sintomas que devem ser valorizados e ativamente questionados, sobretudo nos doentes medicados com bifosfonatos. Independentemente deste risco potencial, os bifosfonatos continuam a ser os fármacos de primeira linha para a prevenção de fraturas osteoporóticas, devendo a duração do tratamento ser individualizada.

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“…The ASBMR Task Force [6,7] summarized independent reports from 17 different countries. The wide difference of incidence reported from various sources has been attributed to differences in data collecting techniques with actual radiographic examination [15][16][17] generally finding a greater incidence than retrospective review of diagnostic codes. Some of these differences may also be attributable to observer bias, as the challenge of these fractures has occasioned intensely defensive reactions in some quarters.…”

Section: Establishing a Meaningful Definition Of Causationmentioning

confidence: 99%

The Causation of “Bisphosphonate-Associated” Atypical Femur Fractures

Hinshaw¹

2020

BJSTR

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The last decades of the 20 th century saw the development of intense research programs directed toward the reduction of low-trauma fracture risk by the use of preventative medications. It is not the intention here to recite the history of these efforts, as these have been amply described elsewhere. After the turn of the century, it became apparent that the introduction of the bisphosphonate medications for the purpose was associated with a number of unfortunate consequences. Among these number the appearance of unanticipated necrosis of the mandible and/or maxilla and similarly unanticipated (or almost unanticipated) spontaneous fractures of the subtrochanteric femur. There followed a vigorous response by the medical community to these cataclysmic events. This response was exemplified by the convening, after a number of years of case-reports multiplying in the literature, by the American Society of Bone and Mineral Research, of select groups of concerned physicians and scientists tasked with evaluating the origins of these problems.At no time did these so-called Task Forces acknowledge clearly and unambiguously that the preponderance of evidence was consistent with the cause of these dramatic effects being the associated use of the bisphosphonate drugs. The purpose of this opinion paper is to show that the problem of assigning causation, a conundrum which has resulted in contrary opinions of many eminent philosophers, has indeed been convincingly elucidated in a manner that has received acceptance and recognition in the field of applied medicine, and furthermore, to show the application of this technique to the question of the causation of the effects "associated" with the bisphosphonates, with particular reference to the femur fractures mentioned above.

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Audit of Atypical Femoral Fractures and a Description of Some of Their Features

Cited by 9 publications

References 39 publications

Incidence and medical management of bisphosphonate-associated atypical femoral fractures in a major trauma centre: a retrospective observational study

Incidence and medical management of bisphosphonate-associated atypical femoral fractures in a major trauma centre: a retrospective observational study

Uma fratura femoral atípica: relato de caso

The Causation of “Bisphosphonate-Associated” Atypical Femur Fractures

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