Atypical Femoral Fractures due to long-term bisphosphonates therapy

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.