Periprosthetic Atypical Femoral Fractures in Patients on Long-term Bisphosphonates

Robinson, Juan de Dios; Leighton, Ross; Trask, Kelly; Bogdan, Yelena; Tornetta, Paul

doi:10.1097/bot.0000000000000508

Cited by 32 publications

(57 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…However, 8 of 17 fractures occurred close to implanted metal [ 9 ]. A more recent 10-year retrospective study of 15 North American centers defined characteristics of 196 patients with AFFs receiving long-term (> 2 years) BPs in whom the AFF was periprosthetic (PAFF, n = 21) or not periprosthetic (AFF, n = 175) [ 43 ]. Only periprosthetic fractures with atypical features (lateral cortical beaking or hypertrophy, transverse lucency in the lateral cortex, transverse orientation of the fracture in the lateral cortex, minimal comminution) were included.…”

Section: Update On Epidemiologymentioning

confidence: 99%

“…Compared to the literature, several features common to patients with ordinary periprosthetic fractures (history of revision surgery, infection, total hip replacement for previous low-energy hip fracture with/without femoral loosening) were not present in BP-treated patients with PAFFs. Prodromal pain was common in PAFF patients but no data were presented [ 43 ]. While the ASBMR case definition for AFFs excluded periprosthetic fractures, emerging data suggest they may occur.…”

Section: Update On Epidemiologymentioning

confidence: 99%

See 1 more Smart Citation

Current Understanding of Epidemiology, Pathophysiology, and Management of Atypical Femur Fractures

Starr

Tay

Shane

2018

Curr Osteoporos Rep

114

View full text Add to dashboard Cite

Purpose of ReviewTo summarize reports published since the 2013 American Society of Bone and Mineral Research Task Force Report on atypical femoral fractures (AFF).Recent FindingsThe absolute incidence of AFFs remains low. AFFs are primarily associated with prolonged bisphosphonate (BP) exposure, but have also been reported in unexposed patients and those receiving denosumab for osteoporosis and metastatic bone disease. Asians may be more susceptible to AFFs. Lateral femoral bowing and varus hip geometry, which increase loading forces on the lateral femoral cortex, may increase AFF risk. Altered bone material properties associated with BP therapy may predispose to AFFs by permitting initiation and increasing propagation of micro-cracks. Relevant genetic mutations have been reported in patients with AFFs. Single X-ray absorptiometry femur scans permit early detection of incomplete and/or asymptomatic AFFs. Orthopedists recommend intramedullary rods for complete AFFs and for incomplete, radiologically advanced AFFs associated with pain and/or marrow edema on MRI. Teriparatide may advance AFF healing but few data support its efficacy.SummaryGreater understanding of biological and genetic predisposition to AFF may allow characterization of individual risk prior to initiating osteoporosis therapy and help allay fear in those at low risk for this complication, which remains rare in comparison to the osteoporotic fractures prevented by antiresorptive therapy.

show abstract

Section: Update On Epidemiologymentioning

confidence: 99%

Section: Update On Epidemiologymentioning

confidence: 99%

Current Understanding of Epidemiology, Pathophysiology, and Management of Atypical Femur Fractures

Starr

Tay

Shane

2018

Curr Osteoporos Rep

114

View full text Add to dashboard Cite

show abstract

“…Our study defines the strength of association of those criteria with APFFs. Robinson and colleagues also observed transverse or short oblique fractures in APFFs similar to AFFs. Using the Vancouver classification for hip PFFs, there was no significant difference in the distribution between APFFs and PFFs .…”

Section: Discussionmentioning

confidence: 90%

Prevalence and Characteristics of Atypical Periprosthetic Femoral Fractures

Leclerc¹,

Michou

Vaillancourt³

et al. 2018

Journal of Bone and Mineral Research

View full text Add to dashboard Cite

Bisphosphonate use has been associated with atypical femoral fractures (AFFs), defined by the American Society of Bone and Mineral Research (ASBMR) Task Force criteria, which currently exclude periprosthetic fractures. The objectives of this study were to establish the prevalence of atypical periprosthetic femoral fractures (APFFs) in patients with hip and knee arthroplasties and to determine the clinical and radiological risk factors associated with these fractures. We performed a retrospective radiological review of all femoral fractures between January 1, 2006, and March 31, 2015, in Quebec City, Canada. Patients who sustained a periprosthetic femoral fracture (PFF) were identified and included in this study. We used the ASBMR Task Force criteria to identify atypical fractures and establish their prevalence. Data from medical records and radiological assessments of the femoral anatomy, the characteristics of the fracture, and the positioning of the prosthesis were collected. The prevalence of APFFs among PFFs was 8.3% (11/133). A strong association with bisphosphonates (p ¼ 0.007) was observed, as well as an increased risk of APFFs among alendronate users compared to risedronate users (p ¼ 0.04). A transverse fracture (p < 0.0001), a periosteal thickening of the lateral cortex at the fracture (p < 0.0001), a unicortical fracture (p ¼ 0.02), and prodromal symptoms (p ¼ 0.03) were associated with APFFs. The type of implant, its positioning, and the femoral geometry did not appear to be risk factors for APFFs compared to PFFs.

show abstract

“…Levels of PPi in the affected individuals have not been reported, but it is possible that an additive effect is being detected. Periprosthetic fractures characteristics of the BP-associated atypical femoral fractures have also been reported [ 40 ] in patients without OI. These fractures do not appear to be as distinct from stress riser effects as those reported in OI.…”

Section: Resultsmentioning

confidence: 97%

An Evaluative History of Bisphosphonate Drugs: Dual Physiologic Effects of Pyrophosphate as Inspiration for a Novel Pharmaceutical Class

Hinshaw¹,

DeLong

2016

Journal of Osteoporosis

View full text Add to dashboard Cite

The documented history of the development of the bisphosphonate drugs is reviewed in sufficient detail to permit independent evaluation of the consistency of the conclusions reached from the available data. The evidence developed during the early interval of these studies 1960–1975 was sufficient to establish that pyrophosphate shares the subsequently established dual bisphosphonate characteristics of bone resorption inhibition and prevention of tissue mineralization.

show abstract

Periprosthetic Atypical Femoral Fractures in Patients on Long-term Bisphosphonates

Abstract: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Cited by 32 publications

References 31 publications

Current Understanding of Epidemiology, Pathophysiology, and Management of Atypical Femur Fractures

Current Understanding of Epidemiology, Pathophysiology, and Management of Atypical Femur Fractures

Prevalence and Characteristics of Atypical Periprosthetic Femoral Fractures

An Evaluative History of Bisphosphonate Drugs: Dual Physiologic Effects of Pyrophosphate as Inspiration for a Novel Pharmaceutical Class

Contact Info

Product

Resources

About