Low-Energy Femoral Fractures Associated with the Long-Term Use of Bisphosphonates

Lorenzini, Kuntheavy Ing; Desmeules, Jules Alexandre; Plachta, Olivier; Suvà, Domizio; Dayer, P.; Peter, Robin

doi:10.2165/00002018-200932090-00002

Cited by 118 publications

(79 citation statements)

References 34 publications

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“…Caution should be used in interpreting measurements of bone turnover taken from a biopsy at the fracture site. Ing-Lorenzini and colleagues (112) obtained biopsies from two patients but described the histologic appearance of only one of those, a 65-year-old postmenopausal woman who had received alendronate for 5 years and ibandronate for 1 year before suffering a subtrochanteric right femoral shaft insufficiency fracture. Five years earlier and 2 years after starting alendronate, she had sustained a subtrochanteric fracture of her left femur.…”

Section: Atypical Subtrochanteric and Femoral Shaft Fractures: Clinicmentioning

confidence: 99%

Atypical subtrochanteric and diaphyseal femoral fractures: Report of a task force of the american society for bone and mineral Research

Shane

Burr

Ebeling

et al. 2010

Journal of Bone and Mineral Research

999

679

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Reports linking long-term use of bisphosphonates (BPs) with atypical fractures of the femur led the leadership of the American Society for Bone and Mineral Research (ASBMR) to appoint a task force to address key questions related to this problem. A multidisciplinary expert group reviewed pertinent published reports concerning atypical femur fractures, as well as preclinical studies that could provide insight into their pathogenesis. A case definition was developed so that subsequent studies report on the same condition. The task force defined major and minor features of complete and incomplete atypical femoral fractures and recommends that all major features, including their location in the subtrochanteric region and femoral shaft, transverse or short oblique orientation, minimal or no associated trauma, a medial spike when the fracture is complete, and absence of comminution, be present to designate a femoral fracture as atypical. Minor features include their association with cortical thickening, a periosteal reaction of the lateral cortex, prodromal pain, bilaterality, delayed healing, comorbid conditions, and concomitant drug exposures, including BPs, other antiresorptive agents, glucocorticoids, and proton pump inhibitors. Preclinical data evaluating the effects of BPs on collagen cross-linking and maturation, accumulation of microdamage and advanced glycation end products, mineralization, remodeling, vascularity, and angiogenesis lend biologic plausibility to a potential association with long-term BP use. Based on published and unpublished data and the widespread use of BPs, the incidence of atypical femoral fractures associated with BP therapy for osteoporosis appears to be very low, particularly compared with the number of vertebral, hip, and other fractures that are prevented by BPs. Moreover, a causal association between BPs and atypical fractures has not been established. However, recent observations suggest that the risk rises with increasing duration of exposure, and there is concern that lack of awareness and underreporting may mask the true incidence of the problem. Given the relative rarity of atypical femoral fractures, the task force recommends that specific diagnostic and procedural codes be created and that an international registry be established to facilitate studies of the clinical and genetic risk factors and optimal surgical and medical management of these fractures. Physicians and patients should be made aware of the possibility of atypical femoral fractures and of the potential for bilaterality through a change in labeling of BPs. Research directions should include development of animal models, increased surveillance, and additional epidemiologic and clinical data to establish the true incidence of and risk factors for this condition and to inform orthopedic and medical management. ß

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Section: Atypical Subtrochanteric and Femoral Shaft Fractures: Clinicmentioning

confidence: 99%

Atypical subtrochanteric and diaphyseal femoral fractures: Report of a task force of the american society for bone and mineral Research

Shane

Burr

Ebeling

et al. 2010

Journal of Bone and Mineral Research

999

679

View full text Add to dashboard Cite

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“…1) [14]. Patients who sustain these fractures typically report prodromal thigh pain weeks to months before sustaining fractures.…”

Section: Introductionmentioning

confidence: 99%

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

Egol

Park

Rosenberg

et al. 2014

Clinical Orthopaedics &Amp; Related Research

113

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“…Interest in these fractures has increased recently, as many reports have been published suggesting that the distinction between typical and atypical fractures may be related to long-term bisphosphonate use. (1)(2)(3)(4)(5)(6)(7)(8) However, the increased risk of ST/FS fractures in patients taking bisphosphonates long term has not been clearly established and might be related to fragility fractures. (9)(10)(11)(12) Although the incidence of hip fractures has been well characterized, the incidence of ST/FS fractures has only recently been reported.…”

Section: Introductionmentioning

confidence: 99%

Subtrochanteric/femoral shaft Versus hip fractures: Incidences and identification of risk factors

Maravic¹,

Ostertag

Cohen‐Solal

2011

Journal of Bone and Mineral Research

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Subtrochanteric and femoral shaft (ST/FS) fractures are now considered to be fragility fractures in osteoporotic patients. Although rare, there is growing evidence of the burden that they constitute. Little is known about the change over time in incidence of ST/FS fractures. We assessed the incidence of ST/FS fractures and the associated risk factors from 2002 to 2009 compared with those of hip fractures. Data were obtained from the French National Database, which includes all hospital discharge codes from acute care facilities. Hospitalizations for primary surgical management of neck/trochanteric (hip) and ST/FS fractures in patients aged above 50 years were selected and described for different age groups. Incidences per million populations were calculated using the estimated French population adjusted for each year, age, and gender. We studied the change for each fracture site. The comorbidity factors related to these fractures were assessed in 2009 using multivariate logistic regression. From 2002 to 2009, the adjusted incidence of hip fractures decreased continuously from 4368 to 3662 in women ( p < 0.0001), and a mild increase from 1476 to 1384 in men ( p < 0.0001) after an initial decrease. In contrast, the incidence of ST/FS increased significantly in both genders (from 353 to 395 in women, from 146 to 159 in men).

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Low-Energy Femoral Fractures Associated with the Long-Term Use of Bisphosphonates

Abstract: Prescribers should be aware of the possibility of these rare adverse reactions and the prolonged use of bisphosphonates should be reconsidered until long-term robust safety data are available.

Cited by 118 publications

References 34 publications

Atypical subtrochanteric and diaphyseal femoral fractures: Report of a task force of the american society for bone and mineral Research

Atypical subtrochanteric and diaphyseal femoral fractures: Report of a task force of the american society for bone and mineral Research

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

Subtrochanteric/femoral shaft Versus hip fractures: Incidences and identification of risk factors

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