Healing Delayed But Generally Reliable After Bisphosphonate-associated Complete Femur Fractures Treated with IM Nails
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Bisphosphonate therapy for osteoporosis has been associated with atypical femoral fractures. To date, there have been few reports in the literature regarding the preoperative and postoperative courses of patients who have sustained bisphosphonate-associated complete atypical femur fractures.
The purposes of this study were to (1) characterize the preoperative course of patients who eventually presented with bisphosphonate-associated complete atypical femur fractures (duration of bisphosphonate treatment, pain history, risk of converting a nondisplaced fracture to a complete fracture); (2) evaluate the percentage of patients who achieved radiographic union of those fractures after treatment; and (3) determine the patients’ recovery of function using the Short Musculoskeletal Functional Assessment.
Thirty-three patients with 41 atypical, low-energy femur fractures associated with ≥ 5 years of bisphosphonate use were treated with intramedullary nailing between 2004 and 2011 at one center. The main outcome measurements were Short Musculoskeletal Functional Assessment for function and radiographic evaluation for fracture healing. Patients had been treated with bisphosphonates for an average of 8.8 years (range, 5–20 years) before presentation.
Patients reported a mean of 6 months of pain before presentation (range, 1–8 months). Sixty-six percent of patients with surgically treated complete fractures became pain-free and 98% were radiographically healed by 12 months. Sixty-four percent of patients who underwent intramedullary nailing reported a functional return to baseline within 1 year. Patients who reported major functional limitations at latest followup listed pain and apprehension as the major causes of their limitation.
Patients with surgically treated bisphosphonate-associated complete femur fractures achieved generally reliable although delayed fracture healing if malaligned, and nearly two-thirds of patients returned to self-reported baseline function within 1 year.
Level of Evidence
Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
KeywordsFemoral Fracture Ibandronate Complete Fracture Atypical Femoral Fracture Radiographic Union
We thank the NYU Langone Medical Center and the Jamaica Hospital Medical Center for providing the facilities and resources to perform clinical research and contribute to the medical community.
- 2.Black DM, Cummings SR, Karpf DB, Cauley JA, Thompson DE, Nevitt MC, Bauer DC, Genant HK, Haskell WL, Marcus R, Ott SM, Torner JC, Quandt SA, Reiss TF, Ensrud KE. Randomised trial of effect of alendronate on risk of fracture in women with existing vertebral fractures. Fracture Intervention Trial Research Group. Lancet. 1996;348:1535–1541.PubMedCrossRefGoogle Scholar
- 8.Egol KA, Park JH, Prensky C, Rosenberg ZS, Peck V, Tejwani NC. Surgical treatment improves clinical and functional outcomes for patients who sustain incomplete bisphosphonate-related femur fractures. J Orthop Trauma. 2014 Sep 14 [Epub ahead of print].Google Scholar
- 9.Ensrud KE, Barrett-Connor EL, Schwartz A, Santora AC, Bauer DC, Suryawanshi S, Feldstein A, Haskell WL, Hochberg MC, Torner JC, Lombardi A, Black DM. Randomized trial of effect of alendronate continuation versus discontinuation in women with low BMD: results from the Fracture Intervention Trial long-term extension. J Bone Miner Res. 2004;19:1259–1269.PubMedCrossRefGoogle Scholar
- 16.Kanis JA. Assessment of Osteoporosis at the Primary Health-Care Level, WHO Technical Report. Sheffield, UK:WHO Scientific Group,World Health Organization Collaborating Centre for Metabolic Bone Diseases, University of Sheffield; 2007.Google Scholar
- 17.Koval KJ, Zuckerman JD, eds. Fractures in the Elderly. New York, NY, USA: Lippincott-Raven Publishers; 1998.Google Scholar
- 27.Somford MP, Draijer FW, Thomassen BJ, Chavassieux PM, Boivin G, Papapoulos SE. Bilateral fractures of the femur diaphysis in a patient with rheumatoid arthritis on long-term treatment with alendronate: clues to the mechanism of increased bone fragility. J Bone Miner Res. 2009;24:1736–1740.PubMedCrossRefGoogle Scholar
- 28.Wang K, Moaveni A, Dowrick A, Liew S. Alendronate-associated femoral insufficiency fractures and femoral stress reactions. J Orthop Surg (Hong Kong). 2011;19:89–92.Google Scholar