Progression of bisphosphonate-associated impending atypical femoral fracture despite prophylactic cephalomedullary nailing: A case report and review of literature

Maheshwari, Aditya V.; Yarmis, Samantha J.; Tsai, Justin; Jauregui, Julio J.

doi:10.1016/j.jcot.2016.06.003

Cited by 4 publications

(1 citation statement)

References 27 publications

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“…Dietary calcium and vitamin D status should be assessed, and adequate supplementation prescribed. 7 Simple fixation without optimizing bone metabolic profile and stopping any possible influencing factors may prevent healing 53 and even cause failure in these cases. 54 Whether the antiresorptive agents should be discontinued permanently or could be resumed after a ‘drug holiday’ 55 of three to five years is unknown.…”

Section: Medical Treatment and Other Optionsmentioning

confidence: 99%

The enigma of atypical femoral fractures

Larsen

Schmal

2018

EFORT Open Reviews

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Atypical femoral fractures (AFF) are stress or ‘insufficiency’ fractures, often complicated by the use of bisphosphonates or other bone turnover inhibitors. While these drugs are beneficial for the intact osteoporotic bone, they probably prevent a stress fracture from healing which thus progresses to a complete fracture.Key features of atypical femoral fractures, essential for the diagnosis, are: location in the subtrochanteric region and diaphysis; lack of trauma history and comminution; and a transverse or short oblique configuration.The relative risk of patients developing an atypical femoral fracture when taking bisphosphonates is high; however, the absolute risk of these fractures in patients on bisphosphonates is low, ranging from 3.2 to 50 cases per 100,000 person-years.Treatment strategy in patients with AFF involves: radiograph of the contralateral side (computed tomography and magnetic resonance imaging should also be considered); dietary calcium and vitamin D supplementation should be prescribed following assessment; bisphosphonates or other potent antiresorptive agents should be discontinued; prophylactic surgical treatment of incomplete AFF with cephalomedullary nail, unless pain free; cephalomedullary nailing for surgical fixation of complete fractures; avoidance of gaps in the lateral and anterior cortex; avoidance of varus malreduction.Cite this article: EFORT Open Rev 2018;3:494-500. DOI: 10.1302/2058-5241.3.170070.

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