Vitamin D and atypical femoral fractures

A 71-year-old woman who had been taking ibandronate for 10 years presented to an Endocrinology Department with persistent mid-thigh pain. Pelvic X-ray showed bilateral femoral cortical expansion, indicating impending atypical femoral fractures (AFFs). AFFs have been linked to long-term bisphosphonate therapy and have morbidity and mortality similar to that of hip fractures. Such fractures can be averted by regular reviews of bisphosphonate therapy and vigilance for prodromal symptoms. This patient’s bisphosphonate therapy was stopped, and fractures were avoided by treatment with vitamin D and parathyroid hormone.

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Atypical Femoral Fracture in a Patient without Bisphosphonate or Denosumab Exposure-A Case Report

Journal of Orthopaedic Case Reports ◽

10.13107/jocr.2021.v11.i10.2450 ◽

2021 ◽

Vol 11 (10) ◽

Author(s):

George F. Georgiadis ◽

Dimitrios G. Begkas ◽

Konstantinos A. Maniatis ◽

Alexandros E. Vasilakis ◽

Stamatios Theodoros D. Chatzopoulos ◽

...

Keyword(s):

Vitamin D ◽

Femoral Fractures ◽

Subsequent Treatment ◽

Periosteal Reaction ◽

Mineral Research ◽

Osteoporosis Therapy ◽

Atypical Femoral Fractures ◽

Femoral Cortex ◽

Antiresorptive Drugs ◽

American Society

Introduction: Atypical femoral fractures (AFF) are associated with the use of bisphosphonates (BPs) or denosumab. However, few cases that meet the characteristics of these fractures, as established by the American Society of Bone and Mineral Research, have occurred in patients who have never used antiresorptive drugs. Case Report:We report a case of AFF in a 67-year-old woman who had never used antiresorptive medications. The history and comorbidities of the patient, the characteristics of the fracture, and the subsequent treatment are presented. Conclusion: AFFs may occur even in patients who have never been exposed to BPs or denosumab. The absence of antiresorptive osteoporosis therapy and the lack of radiographic focal periosteal reaction in the lateral femoral cortex, as in our case, can make it difficult to detect and prevent the disorder. Prolonged use of proton pump inhibitors and Vitamin D deficiency-related osteomalacia may contribute to the occurrence of these fractures. Further studies are required to accurately understand all inciting factors contributing to the development of AFFs. Keywords: Atypical femoral fractures, subtrochanteric fractures, denosumab, bisphosphonates, antiresorptive drugs.

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Patients with atypical femoral fractures: characteristics, anabolic treatment and long term follow-up

Bone Abstracts ◽

10.1530/boneabs.3.pp333 ◽

2014 ◽

Author(s):

Liana Tripto-Shkolnik ◽

Anat Jaffe

Keyword(s):

Femoral Fractures ◽

Atypical Femoral Fractures ◽

Anabolic Treatment ◽

Long Term Follow Up

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Bilateral atypical femoral fractures after only 4-years of bisphosphonate therapy

Endocrine Abstracts ◽

10.1530/endoabs.50.p066 ◽

2017 ◽

Author(s):

Edouard Mills ◽

Pat Forbes ◽

Michael Yee ◽

Jeremy Cox ◽

Alexander N Comninos

Keyword(s):

Femoral Fractures ◽

Bisphosphonate Therapy ◽

Atypical Femoral Fractures

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Atypical femoral fractures in 2 children treated with bisphosphonates

10.26226/morressier.59020063d462b80292385bf1 ◽

2017 ◽

Author(s):

Benjamin Jacobs

Keyword(s):

Femoral Fractures ◽

Atypical Femoral Fractures

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Pathogenesis, Management and Prevention of Atypical Femoral Fractures

Journal of Bone Metabolism ◽

10.11005/jbm.2015.22.1.1 ◽

2015 ◽

Vol 22 (1) ◽

pp. 1 ◽

Cited By ~ 15

Author(s):

Gun-Il Im ◽

Seung-Hyo Jeong

Keyword(s):

Femoral Fractures ◽

Atypical Femoral Fractures

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Evaluation of the nature and etiologies of risk factors for diaphyseal atypical femoral fractures

Medical Principles and Practice ◽

10.1159/000517484 ◽

2021 ◽

Author(s):

Hiroyuki Tsuchie ◽

Naohisa Miyakoshi ◽

Yuji Kasukawa ◽

Koji Nozaka ◽

Kimio Saito ◽

...

Keyword(s):

Risk Factors ◽

Multivariate Analyses ◽

Femoral Fractures ◽

Japanese Patients ◽

High Serum ◽

Control Group ◽

Atypical Femoral Fractures ◽

Factors Affecting ◽

Lateral Curvature ◽

Low Serum

Objectives: Differences in the mechanisms of subtrochanteric and diaphyseal atypical femoral fractures (AFFs) have been speculated in studies that have analyzed differences in the patients’ backgrounds. However, the etiologies of each type of AFF have not been investigated in detail. Therefore, this study aimed to investigate the nature and etiologies of the risk factors for diaphyseal AFFs. Materials and Methods: Eighty consecutive Japanese patients with 91 diaphyseal AFFs (the AFF group) and 110 age-matched female patients with osteoporosis (the non-AFF control group) were included. Their clinical data were compared and the factors affecting AFFs were investigated. Furthermore, the etiologies of the risk factors for diaphyseal AFFs were examined. Results: Multivariate analysis revealed that femoral serrated changes, bisphosphonate or denosumab usage, and lateral and anterior femoral curvatures were the risk factors for diaphyseal AFFs (p<0.0011, p=0.0137, and p<0.0001, respectively). Multivariate analyses also revealed that serrated changes and low serum 25(OH)D levels affected the lateral curvature (p=0.0088 and 0.0205, respectively), while serrated changes affected the anterior curvature (p=0.0006); each significantly affected the femoral curvature. In addition, a high serum calcium (Ca) level, lateral femoral curvature, and anterior femoral curvature were the predictors of serrated changes (p=0.0146, 0.0002, and 0.0098, respectively). Conclusion: The risk factors for diaphyseal AFFs were bone resorption inhibitor usage, a strong femoral curvature, and serrated changes. A low serum 25(OH)D level and serrated changes are the risk factors for lateral curvature, while a high serum Ca level is a risk factor for serrated changes.

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