Incidence of atypical femoral fractures in the treatment of bone metastasis: An alert report

Kaku, Takumi; Oh, Yoto; Sato, Shingo; Koyanagi, Hirotaka; Hirai, Takashi; Yuasa, Masato; Yoshii, Toshitaka; Nakagawa, Tsuyoshi; Miyaké, Satoshi; Okawa, Atsushi

doi:10.1016/j.jbo.2020.100301

Cited by 12 publications

(17 citation statements)

References 41 publications

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“…bisphosphonates, denosumab, glucocorticoids, or proton pump inhibitors). 2 – 6 , 20 – 22 Figure 1 shows a representative X-ray image of subtrochanteric AFF in a 66-year-old woman who had been taking alendronate for 14 years. Healing of these fractures tends to be delayed because of widespread suppression of bone turnover ( Figure 2 ).…”

Section: Atypical Fracturesmentioning

confidence: 99%

Current concept of stress fractures with an additional category of atypical fractures: a perspective review with representative images

Yamamoto

Yoshii

et al. 2021

Therapeutic Advances in Endocrinology

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Stress fractures have traditionally been classified into three categories: fatigue fractures due to overuse of bone with normal elastic resistance; insufficiency fractures due to everyday physiological stress on fragile bone with poor elastic resistance; and pathologic fractures due to bone weakness involving tumors. The concept of atypical fractures has emerged and is considered a type of stress fracture. However, there has been some inconsistency in interpretation when using the traditional classification of stress fractures, and atypical femoral fractures (AFFs) can potentially be classified into subtypes: “typical” AFFs involving bone turnover suppression due to specific drugs (e.g. bisphosphonates) and fragility fractures of the bowed femoral shaft. In this article, the classification of stress fractures is redefined with the addition of atypical fractures as a fourth category, in which biological activity for fracture healing is absent, to promote consistent understanding and interpretation of clinical conditions involving stress fractures.

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Section: Atypical Fracturesmentioning

confidence: 99%

Current concept of stress fractures with an additional category of atypical fractures: a perspective review with representative images

Yamamoto

Yoshii

et al. 2021

Therapeutic Advances in Endocrinology

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“…( 51 ) However, the majority of publications are case reports or small case series. More recently, a larger study reported an incidence of 0.9% surgically treated cases of AFF (5 of 529 patients) in patients with bone metastases receiving bisphosphonates or denosumab ( 52 ) compared with 0 cases in 192 patients not treated with bone‐modifying agents. Notably, rates of AFF appeared higher (6.6%) in patients with breast cancer compared with other malignancies.…”

Section: Safety Considerationsmentioning

confidence: 99%

“…Notably, rates of AFF appeared higher (6.6%) in patients with breast cancer compared with other malignancies. ( 52 ) This may in part be explained by hip geometry, ( 53 ) and special attention should be paid to AFF in patients with breast cancer. Several other studies have addressed the same topic.…”

Section: Safety Considerationsmentioning

confidence: 99%

Individualized Bone-Protective Management in Long-Term Cancer Survivors With Bone Metastases

Rachner

Coleman

Hadji

et al. 2020

Journal of Bone and Mineral Research

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Antiresorptive therapy is an important component of a multimodal approach to treating patients with advanced malignancies and metastatic bone disease. Over the past decade, overall survival of affected patients has improved in most cancer entities, and long-term disease control is a realistic goal in many cases. There are emerging clinical studies showing the benefits of an initial antiresorptive therapy using bisphosphonates or denosumab. However, some adverse events of these therapies, such as osteonecrosis of the jaw, correlate with the cumulative doses given, and there is an increasing clinical need for new antiresorptive concepts to treat long-term survivors. This review summarizes the clinical evidence of antiresorptive therapies across different cancers with bone involvement and presents concepts of dose-reduction protocols for long-term survivors with established metastatic bone disease.

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“…The use of bone resorption inhibitors such as bisphosphonates and denosumab is recommended for the treatment of patients with bone metastases, and is administered long-term to prevent skeletalrelated events (1,2). However, bone resorption inhibitors can cause severe suppression of bone turnover (SSBT).…”

Section: Introductionmentioning

confidence: 99%

Case Report: Prophylactic Plate Fixation for Incomplete Atypical Ulnar Fractures Resulting From the Use of Denosumab for Bone Metastases

et al. 2022

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Patients with bone metastases are treated with long-term bone resorption inhibitors such as bisphosphonates and denosumab. However, resorption inhibitors have been known to cause fractures, such as atypical femoral fractures (AFFs). In recent years, there have been an increasing number of reports of atypical ulna fractures (AUFs) caused by bone resorption inhibitor usage. Treatment of AUFs is complicated, especially when they occur in patients with bone metastases, because it is difficult to discontinue bone resorption inhibitor treatment without the risk of aggravating metastatic lesions. Prophylactic surgery is recommended in AFFs when fractures are predicted, but there are few reports of prophylactic surgery for AUFs. Here, we report a case of incomplete AUF in a 74-year-old woman which was surgically treated with prophylactic plate fixation. The patient had been using denosumab for 6 years to treat bone metastases due to thyroid cancer. After surgery, no fractures were observed for 2 years without discontinuing denosumab, and her forearm function was adequate. AUFs are rare and difficult to treat, so oncologists who treat bone metastases need to pay special attention to diagnose this incomplete AUF before the fracture worsens. We believe that detection of a possible fracture and prophylactic surgery can improve prognosis.

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Incidence of atypical femoral fractures in the treatment of bone metastasis: An alert report

Cited by 12 publications

References 41 publications

Current concept of stress fractures with an additional category of atypical fractures: a perspective review with representative images

Current concept of stress fractures with an additional category of atypical fractures: a perspective review with representative images

Individualized Bone-Protective Management in Long-Term Cancer Survivors With Bone Metastases

Case Report: Prophylactic Plate Fixation for Incomplete Atypical Ulnar Fractures Resulting From the Use of Denosumab for Bone Metastases

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