Surgical outcome of atypical subtrochanteric and femoral fracture related to bisphosphonates use in osteoporotic patients with or without teriparatide treatment

Abstract

BackgroundAtypical subtrochanteric fracture and femoral fracture have been considered to be rare complications related to long-term bisphosphonates use. A reduced bone turnover rate may lead to delayed bone healing. Limited data have revealed that teriparatide treatment may reverse the effect of bisphosphonates and be effective in bone healing.MethodsWe reviewed patients with atypical subtrochanteric and femoral fracture related to bisphosphonates use between January 2008 and December 2014. Thirteen female patients were enrolled. Radiographic findings were compatible with the characteristics of atypical fracture. Surgical intervention was performed for all, and teriparatide use was advised postoperatively. Outcome measures included perioperative results, and clinical and radiographic outcome.ResultsOf the 13 female patients enrolled, 10 had subtrochanteric and 6 had proximal femoral fracture; 3 had bilateral fractures. The mean age of the patients at surgery was 70.15±6.36 years. Most fractures (68.8%) presented prodromal thigh pain. All patients were treated with an intramedullary fixation system without severe complications. The patients were divided into 2 groups based on whether they had received treatment with teriparatide or not. The mean time to bone union was 4.4 months in the teriparatide-treated group, and 6.2 months in the non-teriparatide-treated group (p=0.116). Six patients (75%) in the teriparatide-treated group and 4 (50%) in the non-teriparatide-treated group (p= 0.3) achieved bone union within 6 months. The means of the modified Harris Hip Score and Numerical Rating Scale were significantly better in the teriparatide-treated group at postoperative 6 months. Seven patients had the same ability to walk at the 1-year follow-up as they did before the atypical fracture.ConclusionsTeriparatide treatment in patients with atypical fracture may help in fracture healing, hip function recovery, and pain relief in this reduced bone turnover patient group.

Does Teriparatide Improve Fracture Union?: A Systematic Review

“…All TPTD group showed fast er healing time (5.4±1.5 vs. 8.6±4.7 months; P =0.012), and low frequency of delayed healing or nonunion ( P =0.012) [ 61 ]. Yeh et al [ 62 ] also retrospectively examined 13 female patients with a total of 16 AFFs that all treated with an intramedullary fixation and divided into 2 groups (8 AFFs in TPTD-treated group vs. 8 in non-TPTD group). The mean time to bone union was shorter in the TPTD-treated group (4.4 vs. 6.2 months; P =0.116), and union rate within 6 months was also higher in the TPTD-treated group (75% [6/8] vs. 50% [4/8]; P =0.3) achieved.…”

Treatment strategy for atypical ulnar fracture due to severely suppressed bone turnover caused by long-term bisphosphonate therapy: a case report and literature review

“…Moreover, a previous report has described the usefulness of teriparatide in the treatment of atypical femoral fractures [ 24 ]. Yeh WL, et al reported that the majority of patients (75%) treated with teriparatide treatment could achieve bone union within 6 months, with a mean time period of 4.4 months [ 25 ]. Moreover, a previous case report has described an additive effect of teriparatide and LIPUS during fracture healing [ 26 ].…”

Surgical Fixation of Atypical Femur Fractures in Bisphosphonate-treated Patients

“…We did not use teriparatide treatment for the reversal of the bisphosphonate effect because evidence is still lacking. Some reports suggest their use in bone healing, but an actual comparison with or without teriparatide treatment is not yet available [14]. Fortunately for our patient, we were still able to attain union by only the fixation of the fracture site with intramedullary devices.…”