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Atypical femoral fractures in association with bisphosphonate therapy: a case series

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Abstract

Well-established clinically as frontline therapy in the management of osteoporosis, bisphosphonates have been shown in numerous trials to be highly effective in reducing the risk of both vertebral and hip fractures. More recently, however, in a multitude of exhaustive case reviews, attention has been raised to the small but by now well-established link between prolonged bisphosphonate usage and the risk for atypical subtrochanteric femoral stress fractures. We present herein a trio of illustrative cases highlighting both clinical presentation and characteristic radiological findings thereof, as well as a discussion of the background, management, and natural history of these oftentimes problematic injuries.

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References

  1. Lenart B, Neviaser A, Lyman S et al (2008) Association of low-energy femoral fractures with prolonged bisphosphonate use: a case control study. Osteoporos Int. doi:10.1007/s00198-008-0805-x

    PubMed  Google Scholar 

  2. Giannini S, Chiarello E, Tedesco G et al (2013) Atypical femoral fractures. Clin Cases Miner Bone Metab 10(1):30–33

    PubMed  PubMed Central  Google Scholar 

  3. Kang J, Won Y, Kim J, Min B et al (2014) Atypical femoral fractures after anti-osteoporotic medication: a Korean multicenter study. Int Orthop. doi:10.1007/s00264-013

    Google Scholar 

  4. Odvina C, Zerwekh J, Rao D et al (2005) Severely suppressed bone turnover: a potential complication of alendronate therapy. J Clin Endocrinol Metab 90(3):1294–1301

    Article  PubMed  CAS  Google Scholar 

  5. Abrahamsen B, Eiken P, Eastell R (2010) Cumulative alendronate dose and the long-term absolute risk of subtrochanteric and diaphyseal femur fractures: a register-based national cohort analysis. J Clin Endocinol Metab 95(12):5258–5265

    Article  CAS  Google Scholar 

  6. Kim S, Scheeweiss S, Katz J et al (2011) Oral bisphosphonates and risk of subtrochanteric or diaphyseal femur fractures in a population-based cohort. J Bone Miner Res 26(5):993–1001

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  7. Shane E, Burr D, Abrahamsen B et al (2010) Atypical subtrochanteric and diaphyseal femoral fractures: second report of a task force of the American society for bone and mineral research. J Bone Miner Res. doi:10.1002/jbmr.1998

    Google Scholar 

  8. Bisonette L, April P, Dumais R et al (2013) Atypical fracture of the tibial diaphysis associated with bisphosphonate therapy: a case report. Bone 56(2):406–409

    Article  Google Scholar 

  9. Isaacs J, Shidiak L, Harris I et al (2010) Femoral insufficiency fractures associated with prolonged bisphosphonate therapy. Clin Orthop Relat Res 468(12):3384–3392

    Article  PubMed  PubMed Central  Google Scholar 

  10. Edwards B, Bunta A, Lane J et al (2013) Bisphosphonates and nonhealing femoral fractures: analysis of the FDA Adverse Event Reporting System (FAERS) and international safety efforts: a systematic review from the Research on Adverse Drug Events and Reports (RADAR) project. J Bone Joint Surg Am 95(4):297–307

    Article  PubMed  PubMed Central  Google Scholar 

  11. Rizzoli R, Akesson K, Kanis J et al (2011) Subtrochanteric fractures after long-term treatment with bisphosphonates: a European Society on Clinical and Economic Aspects of Osteoporosis and Osteoarthritis and International Osteoporosis Foundation Working Group project. Osteoporos Int 22(2):373–390

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  12. Nieves J, Cosman F (2010) Atypical subtrochanteric and femoral shaft fractures and possible association with bisphosphonates. Curr Osteoporos Rep. doi:10.1007/s11914-010-0007-2

    PubMed  Google Scholar 

  13. Dorne H, Lander P (1985) Spontaneous stress fractures of the femoral neck. AJR 144:343–347

    Article  PubMed  CAS  Google Scholar 

  14. Porrino J, Kohl C, Taljanovic M et al (2010) Clinical perspective. Diagnosis of proximal femoral insufficiency fractures in patients receiving bisphosphonate therapy. AJR 194:1061–1064

    Article  PubMed  Google Scholar 

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The authors declare that they have no conflicts of interest.

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Correspondence to Matthew Rheinboldt.

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Rheinboldt, M., Harper, D. & Stone, M. Atypical femoral fractures in association with bisphosphonate therapy: a case series. Emerg Radiol 21, 557–562 (2014). https://doi.org/10.1007/s10140-014-1215-3

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  • DOI: https://doi.org/10.1007/s10140-014-1215-3

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