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Healing of bisphosphonate-associated atypical femoral fractures in patients with osteoporosis: a comparison between treatment with and without teriparatide

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Abstract

Atypical femoral fracture (AFF) often appears with bisphosphonate use. Teriparatide (TPTD) treatment may promote AFF healing, but few controlled or comparative studies have examined the effects of TPTD on healing of bisphosphonate-associated AFF. We retrospectively reviewed the medical records of 45 consecutive AFFs in 34 Japanese patients who had received oral bisphosphonates (alendronate or risedronate) for osteoporosis before AFF and had been followed for ≥12 months (range, 12–90 months). Thirty-seven complete or incomplete AFFs (82 %) were treated surgically and eight incomplete AFFs (18 %) were treated conservatively. Bisphosphonates were stopped at diagnosis. Based on TPTD use after fracture, AFFs were divided into non-TPTD (n = 24) and TPTD (n = 21) groups. Time to fracture-healing and frequency of delayed healing or non-union were compared between groups. Because fracture type (complete or incomplete) differed significantly between groups, only subanalyses for all surgically treated AFFs (complete and incomplete), surgically treated complete AFFs, and conservatively treated incomplete AFFs were performed. In subanalyses for all AFFs treated surgically, mean (± standard deviation) time to fracture healing was significantly better in the TPTD group (5.4 ± 1.5 months) than in the non-TPTD group (8.6 ± 4.7 months; P = 0.012), and the frequency of delayed healing or non-union was significantly lower in the TPTD group than in the non-TPTD group (P = 0.014). Subanalyses for surgically treated complete AFFs yielded similar results, but subanalyses for incomplete AFFs treated conservatively showed no significant differences between groups. TPTD treatment appears to significantly shorten the postoperative time to fracture healing and reduce rates of delayed healing or non-union after bisphosphonate-associated AFF.

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Authors and Affiliations

  1. Department of Orthopedic Surgery, Akita University School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan

    Naohisa Miyakoshi, Yuji Kasukawa & Yoichi Shimada

  2. Department of Orthopedic Surgery, Northern Akita Municipal Hospital, KitaAkita, Japan

    Toshiaki Aizawa

  3. Higashinaruse National Health Insurance Clinic, Higashinaruse, Japan

    Satoshi Sasaki

  4. Department of Orthopedic Surgery, Yamamoto-Kumiai General Hospital, Noshiro, Japan

    Shigeru Ando

  5. Department of Orthopedic Surgery, Ogachi Central Hospital, Yuzawa, Japan

    Shigeto Maekawa

  6. Department of Orthopedic Surgery, Kakunodate General Hospital, Senboku, Japan

    Hiroshi Aonuma

  7. Department of Orthopedic Surgery, Nakadoori General Hospital, Akita, Japan

    Hiroyuki Tsuchie

  8. Department of Orthopedic Surgery, Akita-Rosai Hospital, Odate, Japan

    Hiroshi Sasaki

  9. Akita Bone and Osteoporosis Network (A-BONE), Akita, Japan

    Naohisa Miyakoshi, Toshiaki Aizawa, Satoshi Sasaki, Shigeru Ando, Shigeto Maekawa, Hiroshi Aonuma, Hiroyuki Tsuchie, Hiroshi Sasaki, Yuji Kasukawa & Yoichi Shimada

Authors
  1. Naohisa Miyakoshi
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  2. Toshiaki Aizawa
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  3. Satoshi Sasaki
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  5. Shigeto Maekawa
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  7. Hiroyuki Tsuchie
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  8. Hiroshi Sasaki
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  9. Yuji Kasukawa
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  10. Yoichi Shimada
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Corresponding author

Correspondence to Naohisa Miyakoshi.

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Miyakoshi, N., Aizawa, T., Sasaki, S. et al. Healing of bisphosphonate-associated atypical femoral fractures in patients with osteoporosis: a comparison between treatment with and without teriparatide. J Bone Miner Metab 33, 553–559 (2015). https://doi.org/10.1007/s00774-014-0617-3

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  • DOI: https://doi.org/10.1007/s00774-014-0617-3

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