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

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.

scholarly journals Nontraumatic bilateral atypical femoral fractures associated with long-term alendronate therapy

2020 ◽  
Vol 9 (11) ◽  
pp. 1737
Author(s):  
Olayinka A. Ogundipe
Keyword(s):  
Femoral Fractures ◽  
Case Definition ◽  
Term Therapy ◽  
Caucasian Woman ◽  
X Rays ◽  
Medication History ◽  
Mineral Research ◽  
Atypical Femoral Fractures ◽  
Femur Fractures

Alendronate is a bisphosphonate commonly used in the treatment of post-menopausal and steroid-associated osteoporosis. Bisphosphonates have an evidence base for reducing the occurrence of typical osteoporotic fractures. However, there has been growing recognition of a correlation with the use of long-term therapy with bisphosphonates, and rare occurrence of atypical femoral fractures (AFFs). This report describes a 72-year-old caucasian woman presenting with evolving groin and thigh pains of two weeks duration. Plain X-rays noted features compatible with bilateral impending femoral subtrochanteric fractures. She had been taking oral alendronate 70mg weekly for ten consecutive years as treatment for osteoporosis. Based on the medication history, the absence of preceding trauma or a fall, and the presence of supportive radiological findings, the diagnosis was made of impending bilateral proximal femur fractures secondary to long-term bisphosphonate therapy. The alendronate was discontinued, and the patient managed with two planned successive surgeries involving the insertion of intertrochanteric antegrade nails (inter-TAN) to both femurs. Following a period of rehabilitation, she was successfully discharged home. Some pharmacokinetic and pharmacodynamic considerations of bisphosphonates are discussed. The write-up presents a brief literature review of AFFs. The index report is further reviewed in relation to the American society for bone and mineral research (ASBMR) task force’s recommended case definition of what constitutes AFFs. The discussion concludes with the application of two previously validated causality assessment systems (CAS). In this instance, both CAS indicated a ‘probable’ classification for the adverse drug reaction (ADR) to prolonged usage of oral alendronate.

Atypical subtrochanteric and diaphyseal femoral fractures: Report of a task force of the american society for bone and mineral Research

2010 ◽  
Vol 25 (11) ◽  
pp. 2267-2294 ◽  
Author(s):  
Elizabeth Shane ◽  
David Burr ◽  
Peter R Ebeling ◽  
Bo Abrahamsen ◽  
Robert A Adler ◽  
...  
Keyword(s):  
Task Force ◽  
Femoral Fractures ◽  
Mineral Research ◽  
American Society

Atypical subtrochanteric and diaphyseal femoral fractures: Report of a task force of the American Society for Bone and Mineral Research

2011 ◽  
Vol 26 (8) ◽  
pp. 1987-1987 ◽  
Author(s):  
Elizabeth Shane ◽  
David Burr ◽  
Peter R Ebeling ◽  
Bo Abrahamsen ◽  
Robert A Adler ◽  
...  
Keyword(s):  
Task Force ◽  
Femoral Fractures ◽  
Mineral Research ◽  
American Society

scholarly journals Vitamin D and atypical femoral fractures

2012 ◽  
Vol 24 (5) ◽  
pp. 1767-1767 ◽  
Author(s):  
A. C. Ng ◽  
J. S.-B. Koh ◽  
T.-S. Howe
Keyword(s):  
Vitamin D ◽  
Femoral Fractures ◽  
Atypical Femoral Fractures

scholarly journals Beware of bone pain with bisphosphonates

2019 ◽  
Vol 12 (3) ◽  
pp. e225385 ◽  
Author(s):  
Venthan Jeyaratnam Mailoo ◽  
Vidya Srinivas ◽  
Jeremy Turner ◽  
William Duncan Fraser
Keyword(s):  
Vitamin D ◽  
Parathyroid Hormone ◽  
Hip Fractures ◽  
Bone Pain ◽  
Femoral Fractures ◽  
Bisphosphonate Therapy ◽  
Prodromal Symptoms ◽  
Atypical Femoral Fractures ◽  
X Ray

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.

scholarly journals Atypical Subtrochanteric and Diaphyseal Femoral Fractures: Second Report of a Task Force of the American Society for Bone and Mineral Research

2013 ◽  
Vol 29 (1) ◽  
pp. 1-23 ◽  
Author(s):  
Elizabeth Shane ◽  
David Burr ◽  
Bo Abrahamsen ◽  
Robert A Adler ◽  
Thomas D Brown ◽  
...  
Keyword(s):  
Task Force ◽  
Femoral Fractures ◽  
Mineral Research ◽  
American Society

scholarly journals Atypical periprosthetic femoral fractures of the hip: characterisation of three cases

2020 ◽  
Vol 30 (2_suppl) ◽  
pp. 77-85
Author(s):  
Giuseppe Toro ◽  
Ciro Di Fino ◽  
Annalisa De Cicco ◽  
Gabriella Toro ◽  
Marco Paoletta ◽  
...  
Keyword(s):  
Fracture Healing ◽  
Management Strategies ◽  
Femoral Fractures ◽  
Mineral Research ◽  
Periprosthetic Femoral Fractures ◽  
Hip Function ◽  
Lateral Plating ◽  
Oxford Hip Score ◽  
American Society ◽  
Definition Of

Introduction: Long-term use of bisphosphonates (BPs) has been associated with a specific type of tensile side femoral stress fracture known as Atypical Femoral Fracture (AFF). Theoretically periprosthetic femoral fractures (PFF) should be excluded from the diagnosis of AFF. However, emerging evidence correlates prolonged BPs use with the occurrence of a type of PFF with an atypical pattern (atypical PFF, APFF). The aim of the present study is to report 3 cases of APFF treated at a single centre. Methods: Clinical and radiographic records of PFF that occurred between January 2016 and August 2018 were retrospectively reviewed. All patients meeting the American Society for Bone and Mineral Research (ASBMR) criteria for definition of PFF were included. Management strategies for APFF and patient outcomes, including fracture healing and hip function (assessed by the Oxford Hip Score [OHS]) were collected. Results: 3 patients in the study period were identified as APFF (1 incomplete, 2 complete). All patients were females with a mean age of 83.3 years. All patients were treated with lateral plating. The application of a contralateral strut allograft resulted in fracture healing in cases of complete fractures. Mean OHS at final follow-up was 34.3. Conclusions: Despite occurring around a hip stem like PFF, APFF had peculiar clinical and radiographic features, making them more similar to AFF. Therefore, the orthopaedic surgeon should also consider the natural history and healing problems associated with AFF prior in order to choose the most appropriate management for APFF.

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