Long-Term Alendronate Use Not without Consequences?

A previously unknown side effect of biphosphonate use is emerging. In a specific patient group on long term biphosphonate therapy stress femur fractures seem to occur. The typical presentation consists of prodromal pain in the affected leg and/or a discrete cortical thickening on the lateral side of the femur in conventional radiological examination or the presentation with a spontaneous transverse subtrochanteric femur with typical features. We present three cases of this stress fracture in patients on bisphosphonate therapy. One of these patients suffered a bilateral femur fracture of the same type. In our opinion, in patients on bisphosphonate therapy who present with a spontaneous femur fracture, seizing therapy is advisable. In bilateral cases preventive nailing should be considered.

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Selected life quality variables of women treated surgically due to intertrochanteric femur fractures in the aspect of nursing and rehabilitation standards

Rehabilitacja Medyczna ◽

10.5604/01.3001.0010.8158 ◽

2018 ◽

Vol 21 (3) ◽

pp. 4-13

Author(s):

Małgorzata Kamińska ◽

Joanna Golec ◽

Dorota Czechowska

Keyword(s):

Quality Of Life ◽

Femur Fracture ◽

Femoral Fractures ◽

Femur Fractures ◽

Short And Long Term ◽

Intertrochanteric Femur Fracture ◽

Long Term Observation ◽

Nursing Standards

Introduction: The aim of presented study was to evaluate selected quality of life indicators for women treated surgically due to intertrochanteric femur fractures in terms of implementation of physiotherapeutic and nursing standards. Clinical Hospital in Krakow (5WSK) within the period from January 2015 to December 2016. At that time, 145 women with intertrochanteric femur fracture were admitted to the hospital. The age of the patients ranged between 58 and 92 years, with an average of 83.6 years. The following questionnaires and score scales were used to assess the quality of life: Short Pfeiffer Mental Status Questionnaire (SPMSQ), Instrumental Activities of Daily Living (IADL) scale, SF-36 Quality of Life Questionnaire, Barthel scale, HOOS scale, Geriatric Depression Scale (GDS) by Yesavage, the author’s questionnaire on rehabilitation care problems related to urinary tract infections, bed sores, pneumonia, gastrointestinal disorders, gastrointestinal infections and thromboembolic complications as well as survival rate. Results and conclusions: 1. The quality of life of women operated because of intertrochanteric femoral fractures using an intramedullary Gamma nail had deteriorated in both short and long-term observation. 2. Maintenance and individualization of nursing standards and rehabilitation in women treated surgically due to intertrochanteric femoral fractures had a positive effect on the overall process of their treatment. 3.The level of physical activity declared by women operated due to intertrochanteric femur fracture prior to the occurrence of these fractures, has a signifi cant effect on their functional results in short and long-term observation. The higher the level of physical activity of these patients before the fracture, the more favourable was the functional outcome. 4. The level of mood and self-acceptance of the disease in women treated surgically for this fracture had signifi cant impact on the process of their nursing as well as rehabilitation, and on functional status in short and long-term follow-up. The higher the level of mood and self-acceptance of the disease in these women, the better the process of their nursing, rehabilitation and the functional outcome.

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Patients With Un-Displaced Or Displaced Intra Capsular Proximal Femur Fractures Do Not Represent A Different Patient Group And Have Similar Short And Long Term Mortality.

Injury ◽

10.1016/j.injury.2022.01.014 ◽

2022 ◽

Author(s):

Soubhik Ghosh ◽

Bijai Thomas ◽

Prashanth D'sa ◽

Anoop John ◽

Giovanni Dall’ Amico ◽

...

Keyword(s):

Patient Group ◽

Proximal Femur ◽

Proximal Femur Fractures ◽

Femur Fractures ◽

Short And Long Term ◽

Long Term Mortality

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Long-term risks of bisphosphonate therapy

Arquivos Brasileiros de Endocrinologia & Metabologia ◽

10.1590/0004-2730000003308 ◽

2014 ◽

Vol 58 (5) ◽

pp. 523-529 ◽

Cited By ~ 14

Author(s):

Nelson B. Watts

Keyword(s):

Lower Risk ◽

Observational Studies ◽

Osteonecrosis Of The Jaw ◽

Bisphosphonate Therapy ◽

Safety Issues ◽

Femur Fractures ◽

Atypical Femur Fractures ◽

Post Marketing ◽

Risk Patients

The objective this study was to summarize long-term risks associated with bisphosphonate therapy. Search of relevant medical publications for data from clinical trials, trial extensions, observational studies and post-marketing reports. Trial extensions and modifications did not reveal significant long-term safety issues. Observational data suggest at least as many benefits as risks. Post-marketing reports of musculoskeletal pain, osteonecrosis of the jaw and atypical femur fractures have been widely circulated in the lay press. Most focus on long-terms risks has been on osteonecrosis of the jaw and atypical femur fractures which occur in patients who have not received bisphosphonate therapy but may be more frequent (though still uncommon) in patients who have been on treatment for 5 years or longer. Lower-risk patients may be able to stop treatment after 3-5 years for a “drug holiday,” which mitigates these long-term risks; for higher risk patients, therapy through 6-10 years appears to be advisable and offers more benefits than risks.

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Antiresorptive-associated spontaneous fractures of both tibiae, followed by an atypical femur fracture during the sequential treatment with alendronate, denosumab then teriparatide

BMJ Case Reports ◽

10.1136/bcr-2019-229366 ◽

2019 ◽

Vol 12 (7) ◽

pp. e229366 ◽

Cited By ~ 3

Author(s):

Juan Tan ◽

Hiroshige Sano ◽

Kenneth Poole

Keyword(s):

Juvenile Idiopathic Arthritis ◽

Femur Fracture ◽

Bisphosphonate Therapy ◽

Antiresorptive Therapy ◽

Atypical Fracture ◽

Atypical Femur Fracture ◽

Atypical Fractures ◽

Alendronate Treatment ◽

Careful Investigation

A 35-year-old man with juvenile idiopathic arthritis since childhood presented with bilateral atypical tibial fractures, followed by a later, single atypical fracture of the femur. The fractures were associated with 6 years of oral alendronate treatment immediately followed by subcutaneous denosumab therapy and later teriparatide therapy for osteoporosis. Atypical fractures are known to occur in the femur following bisphosphonate therapy; however, there are only a few documented cases of atypical fractures in the tibia. Our case highlights a rare but serious complication of a commonly prescribed antiresorptive agent. It also shows that teriparatide, while helpful in increasing bone mass, does not fully prevent the development of atypical fractures. Careful investigation should be considered in patients on long-term antiresorptive therapy presenting with bony tenderness to exclude an atypical fracture.

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Re: Absence of femoral cortical thickening in long-term bisphosphonate users: Implications for atypical femur fractures

Bone ◽

10.1016/j.bone.2014.06.024 ◽

2014 ◽

Vol 68 ◽

pp. 165

Author(s):

Yueju Liu ◽

Yingze Zhang

Keyword(s):

Cortical Thickening ◽

Femur Fractures ◽

Atypical Femur Fractures

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Atypical Femur Fracture in the Setting of Long-Term Bisphosphonate use for Osteogenesis Imperfecta: A Case Report

Journal of Surgical Case Reports and Images ◽

10.31579/2690-1897/094 ◽

2022 ◽

Vol 5 (1) ◽

pp. 01-09

Author(s):

Parker J. Prusick ◽

Steven D. Jones Jr. ◽

Jesse Roberts ◽

Nathan Donaldson

Keyword(s):

Case Report ◽

Osteogenesis Imperfecta ◽

Femur Fracture ◽

Mineral Density ◽

Mineral Research ◽

Femur Fractures ◽

Atypical Femur Fractures ◽

Impending Fracture

Bisphosphonate (BP) therapy for moderate to severe osteogenesis imperfecta (OI) has become a mainstay of treatment in the last three decades. Given the significant improvements in bone mineral density and theoretical reductions in fracture risk, many patients are treated with bisphosphonates for prolonged periods of time. There currently lacks consensus in the optimal duration of BP therapy for patients with OI, and patients are often treated on a case-by-case basis. Long-term BP therapy has been associated with atypical femur fractures in adult patients treated for osteoporosis. The American Society for Bone and Mineral Research concluded that the median duration of BP therapy in patients with atypical femur fractures was 7 years. The role of long-term BP therapy in OI patients with atypical femur fractures remains unclear. Here, a case report is presented of an adolescent patient with type V OI that sustained a subtrochanteric femur fracture with features of an atypical pattern following treatment with intravenous pamidronate for 10.5 years. At the time of injury, the contralateral femur was also found to have atypical features suggestive of an impending fracture. The completed fracture was treated with closed reduction and cephalomedullary nail fixation. The impending fracture was prophylactically stabilized using the same technique. Prior to the injury, limb-length radiographs obtained to evaluate lower extremity alignment demonstrated features of an impending fracture but went unnoticed. Further studies are needed to clarify the role of long-term BP therapy in patients with OI suffering from atypical femur fractures.

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