Prevalence of Precursory Signs of Atypical Femoral Fractures in Patients Receiving Bone‐Modifying Agents for Bone Metastases: A Cross‐Sectional Study

Abstract

Patients on bone-modifying agents (BMAs) for bone metastases are at risk of atypical femoral fractures (AFFs), which can lead to a sudden deterioration in performance status. In this study, we sought to determine the prevalence of radiographic precursory signs of AFF in patients on oncologic BMAs. Forty-two patients (23 men, 19 women; mean age 68.8 AE 10.0 years) on oncologic BMAs (zoledronate for >3 years and/or denosumab for >1 year) and without clinical symptoms were enrolled between 2019 and 2021. All patients were receiving denosumab at enrollment and 5 had previously used zoledronate. The mean duration of BMA use was 31.2 AE 18.5 months. Radiographs of both femurs were screened for precursory signs of AFF (e.g., thickening of the lateral cortex). The patients were divided into two groups according to thickening status and compared by duration of BMA use. They were also divided into three groups by duration of BMA use (12-23 months, n = 18; 24-59 months, n = 19; ≥60 months, n = 5), and the prevalence of apparent thickenings was examined. As a result, 18 patients (42.9%) showed minute local or diffuse thickening and 10 (23.8%) showed apparent local thickening. The duration of BMA use was significantly longer in patients with apparent thickening than in those without (47.3 AE 23.6 months [n = 10] versus 26.2 AE 13.5 months [n = 32]; p < 0.05). The prevalence of apparent thickening increased with increasing duration of BMA use (12-23 months, 5.6%; 24-59 months, 31.6%; ≥60 months, 60.0%). In conclusion, radiographic precursory signs of AFF are common in patients on oncologic BMAs. Radiographic screening for AFF could be relevant in patients who have been on long-term oncologic BMAs, even if asymptomatic.

Positive und negative (Neben)Effekte bei Osteoporose-Sequenztherapie

“…135 Hüftfrakturen) durch eine Osteoporosetherapie verhindert wurden. Im Falle onkologischer Therapieindikationen liegt das Risiko für AFF aufgrund der höheren und häufigeren Dosierungen wie bei der MRONJ deutlich höher [27].…”

“…Es sind mehrere Risikofaktoren für AFF bekannt, darunter asia tische Ethnie (in Nordamerika), FemurKrümmung, laufende GlukokortikoidTherapie oder genetische Faktoren [28], wobei nicht selten Mutationen im Sinne von seltenen Knochenerkrankun gen gefunden wurden. Frühzeichen für Frakturen [27] umfassen typische Röntgen oder DXAVeränderungen mit fokalen Verdi ckungen des Cortex an den FemoraDiaphysen oder klinische Zei chen wie lokale Schmerzen (▶ Tab. 1), die bisher möglicherweise noch zu wenig beachtet worden sind.…”