Retrospective review of patients with atypical bisphosphonate related proximal femoral fractures

Phillips, Hannah; Harrison, Simon; Akrawi, H.; Sidhom, Sameh

doi:10.1016/j.injury.2017.03.025

Cited by 18 publications

(12 citation statements)

References 16 publications

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“…[ 11 , 12 ] Bisphosphonates are used most commonly for osteogenesis imperfecta and can mediate increased bone mineral density and decreased long bone fracture. [ 13 ] But bisphosphonates have also been linked to an increased risk of atypical femoral fracture, [ 14 – 16 ] with a 70% risk increase in one meta-analysis. [ 17 ]…”

Section: Discussionmentioning

confidence: 99%

Risk factors for nonunion of bone fracture in pediatric patients

et al. 2018

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Adult fracture nonunion risk is related to injury severity and surgical technique, yet nonunion is not fully explained by these risk factors alone; biological risk factors are also important. We test a hypothesis that risk factors associated with pediatric fracture nonunion are similar to adult nonunion risk factors.Inception cohort study in a large payer database of pediatric fracture patients (0–17 years) in the United States in calendar year 2011. Continuous enrollment in the database was required for 12 months, to allow time to capture a nonunion diagnosis. The final database collated demographic descriptors, treatment procedures as per Current Procedural Terminology (CPT) codes, comorbidities as per International Statistical Classification of Diseases and Related Health Problems (ICD-9) codes, and drug prescriptions as per National Drug Code Directory (Red Book) codes. Logistic regression was used to calculate odds ratios (ORs) for variables associated with nonunion.Among 237,033 pediatric fractures in 18 bones, the nonunion rate was 0.85%. Increased nonunion risk was associated with increasing age, male gender, high body-mass index, severe fracture (e.g., open fracture, multiple fractures), and tobacco smoking (all, P < .0001). Nonunion rate varied with fracture location; scaphoid, neck of femur, and tibia/fibula were most likely to go to nonunion. Nonunion ORs were significantly increased for risk factors including; surgical procedure, cardiovascular disease, Vitamin D deficiency, osteoarthritis, osteoporosis, and opioid prescription (all, multivariable P < .001).Nonunion is rare in pediatric patients, but nonunion risk increases with increasing age. We confirm a hypothesis that risk factors for pediatric nonunion are similar to adult nonunion risk factors. Scaphoid fractures in adolescents have nearly the same risk of nonunion as in adults. Opioids should be used cautiously in pediatric patients, as they are associated with a significant and substantial elevation of nonunion risk.Level of Evidence: Prognostic study, Retrospective, Level II.

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Section: Discussionmentioning

confidence: 99%

Risk factors for nonunion of bone fracture in pediatric patients

et al. 2018

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“…[8] In a study that retrospectively evaluated 12 BP-related AFFs, nine patients (75%) were reported to have prodromal pain symptoms. [15] In another multicenter retrospective study, it was reported that 34% of the patients had previously reported prodromal pain on the fracture site. [10] In our study, 12 of 19 of the patients (63%) had prodromal pain, consistent with the rates reported in the literature.…”

Section: Discussionmentioning

confidence: 98%

“…Although it is still controversial, there are some opinions that metabolic disorders and corticosteroids facilitate the development of AFF in BP users. [7,10] In a study published by Phillips et al, [15] six out of 12 patients (50%) with BP-related AFF had a metabolic disorder (polymyalgia, rheumatica, hypothyroidism, nephritic syndrome), and two of these six patients were under corticosteroid treatment. In another case series, 25% of the patients were reported to have a metabolic disorder (rheumatoid arthritis, Addison's disease) and corticosteroid use.…”

Section: Discussionmentioning

confidence: 99%

“…Regardless of the surgical technique used, there are studies reporting that BP-related AFFs have a high rate of nonunion, delayed union, and these fractures are associated with higher complication and revision surgery rates than typical femoral fractures. [7,8,10,15,[22][23][24] In a retrospective study, the mean union time was reported to be 24 weeks and the authors stated that union time reached up to 56 weeks for some patients. [15] In another study, it was reported that 46% of the patients with AFF who were treated with IMN had additional interventions due to lack of union.…”

Section: Discussionmentioning

confidence: 99%

“…[7,8,10,15,[22][23][24] In a retrospective study, the mean union time was reported to be 24 weeks and the authors stated that union time reached up to 56 weeks for some patients. [15] In another study, it was reported that 46% of the patients with AFF who were treated with IMN had additional interventions due to lack of union. [24] The findings in our study are consistent with these results.…”

Section: Discussionmentioning

confidence: 99%

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Atypical femoral fractures related to bisphosphonate use: a comprehensive review of 19 patients

Şahin

Ergin

Bayram

et al. 2019

Ulus Travma Acil Cerrahi Derg

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BACKGROUND: Atypical femur fracture is a rare complication of bisphosphonate treatment, which is widely used for the prevention of osteoporotic fractures. This study aims to report clinical and radiological features and outcomes of surgically treated atypical femur fractures related to bisphosphonates. METHODS: We retrospectively reviewed patients with the diagnosis of atypical femur fracture who were under bisphosphonate treatment and who were surgically treated in our clinic between January 2009 and December 2017. Patients who met the atypical femur fracture criteria defined by the American Society for Bone and Mineral Research were included in this study. Radiological features of the fractures, bisphosphonate treatment and duration, prodromal clinical and radiological findings were evaluated. Outcome measures included perioperative results, clinical and radiological outcomes and mobilization status. RESULTS: In this study, 19 patients were enrolled. Mean age of the patients was 69.6 years (range: 60.8-85.1) and the mean follow-up was 33.8 months (range: 13-104). Mean bisphosphonate use duration was 8.65 years (range: 3-18). Four patients had bilateral fractures. Eight of 23 fractures were subtrochanteric and 15 were diaphyseal. Twenty-one fractures were treated with an intramedullary nail, one fracture with a locked compression plate and one fracture with cephalomedullary nail. Union was observed in 15 fractures within the first six months. There was a delayed union in four fractures and non-union in four fractures. Mean union time was 5.1 months (range: 2-9). While seven patients preserved their preoperative mobilization status, 12 patients showed regression after the fracture. CONCLUSION: This study suggests that atypical femur fractures may have prodromal signs and that their management is complex due to high complication and nonunion rates.

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Stress Fractures in Sport: Hip

Harris

2021

Fractures in Sport

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Retrospective review of patients with atypical bisphosphonate related proximal femoral fractures

Cited by 18 publications

References 16 publications

Risk factors for nonunion of bone fracture in pediatric patients

Risk factors for nonunion of bone fracture in pediatric patients

Atypical femoral fractures related to bisphosphonate use: a comprehensive review of 19 patients

Stress Fractures in Sport: Hip

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