Introduction. Bisphosphonates (BPs) represent the main therapy in patients with osteoporosis, although a long-term treatment can lead to atypical fractures.
Material and methods. We conducted a retrospective study between 2008 and 2017 and included 23 female patients with atypical femoral fractures (AFFs). The mean period of BPs therapy administration was 5.2 years. We included 7 subtrochanteric fractures and 18 femoral shaft fractures. Two of the total patients presented bilateral femoral fractures. 18 patients presented prodromal symptoms from 2 to 18 months before the diagnosis of fractures, all of them following low energy trauma. All the patients included in our study underwent surgery with intramedullary nail or gamma nail. The postoperative mean follow-up was 2 years. Results. Of all 23 female patients with a total of 25 fractures – 10 underwent osteosynthesis with gamma nail and 15 underwent osteosynthesis with intramedullary nail. From the total number of patients: 13 patients achieved complete union, 6 presented delayed union and 3 non-union (2 intramedullary nail and one gamma nail), whereas in one patient treated previously with gamma nail we observed implant failure.
Conclusion. The treatment of AFFs after BPs therapy administration represents a challenge for orthopaedic surgeons regarding both surgical technique and postoperative follow-up.
If the inline PDF is not rendering correctly, you can download the PDF file here.
1. Med AJ. Consensus development conference: diagnosis prophylaxis and treatment of osteoporosis. Am J Med. 1993; 94:646-50.
2. Nieves JW Cosman F. Atypical subtrochanteric and femoral shaft fractures and possible association with bisphosphonates. Curr Osteoporos Rep. 2010; 8:34–39.
3. Neviaser AS Lane JM Lenart BA Edobor-Osula F Lorich DG. Low-energy femoral shaft fractures associated with alendronate use. J Orthop Trauma. 2008; 22:346–350.
4. Bone HG Schurr W. Intravenous bisphosphonate therapy for osteoporosis: where do we stand?. Curr Osteoporos Rep. 2004; 2:24–30.
5. Odvina CV Zerwekh JE Rao DS Maalouf N Gottschalk FA Pak CY. Severely suppressed bone turnover: a potential complication of alendronate therapy. J Clin Endocrinol Metab. 2005; 90:1294-301.
6. Higgins M Morgan-John S Badhe S. Simultaneous bilateral complete atypical femoral fractures after longterm alendronate use. Journal of Orthopaedics. 2016; 13:401-403.
7. Shane E Burr D Ebeling PR et al. Atypical subtrohanteric and diaphyseal femoral fractures: report of a task force of the American Society for Bone and Mineral Research. J Bone Miner Res. 2010; 25:2267-94.
8. Dell R Greene D Ott S et al. A Retrospective Analysis of all Atypical Femur Fractures Seen in a Large California HMO from the Years 2007 to 2009. J Bone Miner Res. 2010; (Suppl 1):1201.
9. Schilcher J Michaelsson K Aspenberg P. Bisphosphonate use and atypical fractures of the femoral shaft. N Engl J Med. 2011; 364:1728–37.
10. Yamagami Y Mashiba T Iwata K et al. Effects of minodronic acid and alendronate on bone remodeling microdamage accumulation degree of mineralization and bone mechanical properties in ovariectomized cynomolgus monkeys. Bone. 2013; 54:1-7.
11. Allen MR Burr DB. Changes in vertebral strengh-density and energy absorption-density relationships following bisphosphonate treatment in beagle dogs. Osteoporos Int. 2008; 19:95-99.
12. Lee KJ Yoo JJ Oh KJ et al. Surgical outcome of intramedullary nailing in patients with complete atypical femoral fractures: a multicenter retrospective study. Injury Int J Care Injured. 2017; 48:941-945.
13. Teo BJ Koh JS Goh SK et al. Post-operative outcomes of atypical femoral subtrochanteric fracture in patients on bisphosphonates therapy. Bone Joint J. 2014; 96-b(5):658-664.