Abstract
Summary
There is still no clarity on the etiology and epidemiology of atypical femoral fractures. The purpose is to show, after a radiological review, that the incidence of atypical fractures is higher than that reported in the literature when compared to “typical” fractures that occurred in the same anatomical site.
Introduction
At present, it is difficult to define the true incidence of atypical fractures associated with bisphosphonate. Our purpose is to show that the incidence of atypical fractures is higher than that reported in the literature when compared to “typical” fractures that occurred in the same anatomical site.
Methods
The authors analyzed 319 femoral fracture Rxs of patients over 60 who have had access to the PS of Clinical Orthopaedics and Traumatology II of the University of Pisa from January 2011 to February 2013. The atypical fractures have been investigated from clinical point of view, biohumoral exams, densitometry and contralateral femur X-rays, and in one case using SPECT-Tc.
Results
The total number of femoral fractures was 319. The medial femur fractures were 60 (46 females and 14 males), and the lateral ones were 316 (237 females and 79 males). Subtrochanteric and diaphyseal fractures were 40 (29 females and 11 males). Among these cases, two atypical fracture cases were related to female patients, one was 79 years old and the other was 77.
Conclusions
The most recent literature reports that the incidence of atypical fractures is 0.6 %. However, taking into consideration only the fracture locations suitable for the identification of atypical fractures, the percentage rises to 5 %. To date, there is still no clarity on the exact etiology of fractures even if it seems to be related to a bone mineral component alteration.
Similar content being viewed by others
References
Gradi MK, Watson JT, Cannada LK (2012) Treatment of femoral fracture nonumion after long-term bisphosphonate. Orthopedics 35(6):e991–995
American College of Rheumatology (2001) Reccomendations for the prevention and treatment of glucocorticoid-induced osteoporosis. Arthritis Rheum 44:1496–1503
Cranney A, Tugwell P, Adachi J, Weaver B, Zytaruk N, Papaioannou A et al (2002) Meta-analysis of risedronate for the treatment of postmenopausal osteoporosis. Endocr Rev 23:517–523
Cranney A, Wells G, Willan A, Griffith L, Zytaruk N, Robinson V et al (2002) Meta-analysis of alendronate for the treatment of postmenopausal women. Endocr Rev 23:508–516
Odvina CV, Zerwekh JE, Rao DS, Maalouf N, Gottschalk FA, Pak CY (2005) Severely suppressed bone turnover: a potential complication of alendronate therapy. J Clin Endocrinol Metab 90(3):1294–1301
Lenart BA, Lorich DG, Lane JM (2008) Atypical fractures of the femoral diaphysis in postmenopausal women taking alendronate. N Engl J Med 358(12):1304–1306, 20
Annanuntana A, Unnanuntana A, Saleh A, Mensah KA, Kleimeyer JP, Lane JM (2013) Atypical femoral fractures: what do we know about them? J Bone Joint Surg Am 95:e8 (1–13)
Abrahamsen B, Eiken P, Eastell R (2009) Subtrochanteric and diaphyseal femur fractures in patients trested with alendronate: a register-based national cohort study. J Bone Miner Res 24:1095–1102
Giusti A, Hamdy NAT, Dekkers OM, Ramautar SR, Dijkstra S, Papapoulos SE (2011) Atypical fractures and bisphosphonate therapy: a cohort study of patients with femoral fracture with radiographic adjudication of fracture site and features. Bone 48:966–971
Girgis CM, Seibelet MJ (2011) Atypical femur fractures: a review of the evidence and its implication to clinical practice. Ther Adv Musculoskelet Dis 3(6):301–314, 011 Dec
Compston J (2011) Pathophysiology of atypical femoral fractures and osteonecrosis of the jaw. Osteoporos Int 22:2951–2961. doi:10.1007/s00198-011-1804-x
Mashiba T et al (2011) Effects of suppressed bone turnover by bisphosphonates on microdamage accumulation and biomechanical properties in clinically relevant skeletal sites in beagles. Bone 28(5):524–531
Carvalho NNC, Voss LA et al (2011) Atypical femoral fractures during prolongued use of bisphosphonates: short-term responses to strontium ranelate and teriparatide. J Clin Metab. doi:10.1210/jc.2011-0593
Dell RM, Adams AL, Greene DF, Funahashi TT, Silverman SL, Eisemon EO, Zhou H, Burchette RJ, Ott SM et al (2012) Incidence of atypical nontraumatic diaphyseal fractures of the femur. J Bone Miner Res 27(12):2544–2550
Giannotti S, Bottai V, Dell’Osso G, De Paola G, Ghilardi M, Guido G (2013) Pseudoarthrosis in atypical femoral fracture: case report. Osteoporos Int. doi:10.1007/s00198-013-2397-3
Giannotti S, Bottai V, Dell’Osso G, De Paola G, Pini E, Guido G (2012) Atrophic femoral nonunion successfully treated with teriparatide. Eur J Orthop Surg Traumatol. doi:10.1007/s00590-012-1143-4
Conflicts of interest
None.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Bottai, V., Giannotti, S., Dell’osso, G. et al. Atypical femoral fractures: retrospective radiological study of 319 femoral fractures and presentation of clinical cases. Osteoporos Int 25, 993–997 (2014). https://doi.org/10.1007/s00198-013-2546-8
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00198-013-2546-8