scholarly journals MANAGEMENT OF ENDOCRINE DISEASE: Atypical femoral fractures: risks and benefits of long-term treatment of osteoporosis with anti-resorptive therapy

2018 ◽  
Vol 178 (3) ◽  
pp. R81-R87 ◽  
Author(s):  
Robert A Adler
Keyword(s):  
Osteoporotic Fracture ◽  
Femoral Fractures ◽  
Osteoporosis Treatment ◽  
Term Treatment ◽  
Atypical Femoral Fractures ◽  
Treatment Of Osteoporosis ◽  
Endocrine Disease ◽  
Long Term Treatment ◽  
Term Management

Modern osteoporosis treatment began in the mid-1990s with the approval of amino-bisphosphonates, anti-resorptive agents that have been shown to decrease osteoporotic fracture risk by about half. In 2005, the first cases of atypical femoral fractures (AFF), occurring in the shaft of the femur, were reported. Since then, more cases have been found, leading to great concern among patients and a dramatic decrease in bisphosphonate prescribing. The pathogenesis and incidence of AFF are reviewed herein. Management and an approach to prevention or early detection of AFF are also provided. Denosumab, a more recently approved anti-resorptive medication has also been associated with AFF. Long-term management of osteoporosis and prevention of fracture are challenging in light of this serious but uncommon side effect, yet with an aging population osteoporotic fracture is destined to increase in frequency.

scholarly journals MANAGEMENT OF ENDOCRINE DISEASE: Treatment breaks in long-term management of osteoporosis

2019 ◽  
Vol 180 (1) ◽  
pp. R29-R35 ◽  
Author(s):  
Bente L Langdahl
Keyword(s):  
Management Plan ◽  
Term Treatment ◽  
Response To Treatment ◽  
Current Evidence ◽  
Endocrine Disease ◽  
Common Chronic Disease ◽  
Long Term Treatment ◽  
Future Fracture ◽  
Term Management

Osteoporosis is a common chronic disease and therefore a long-term management plan based on disease severity, comorbidities, other pharmacological treatments, gender, age and patient preferences is necessary. Consideration of treatment breaks may be included in the long-term management plan if the patient has been treated with a bisphosphonate, the disease is less severe, the response to treatment has been satisfactory and the risk of future fracture is estimated to be low. This perspective reviews the current evidence for long-term treatment with bisphosphonates and off treatment effects. Approaches to decision making and monitoring of treatment breaks are discussed.

scholarly journals Fraturas Atípicas do Fémur Associadas a Terapêutica Prolongada com Bisfosfonatos

2013 ◽  
Vol 26 (6) ◽  
pp. 746
Author(s):  
Francisco Flores Santos ◽  
José Pinheiro da Silva ◽  
Paulo Felicíssimo
Keyword(s):  
Femoral Fracture ◽  
Scientific Evidence ◽  
Femoral Fractures ◽  
Osteoporotic Fractures ◽  
Femoral Shaft ◽  
Term Treatment ◽  
Atypical Femoral Fractures ◽  
Long Term Treatment

Introduction: Long-term treatment with bisphosphonates has been associated to atypical femoral fractures whose features are now clearly defined.Clinical Cases: We present two cases of female patients under bisphosphonate treatment for over 10 years who were admitted to our institution for subtrochanteric and femoral shaft fractures after low-energy trauma. They presented, respectively, a transverse and a short oblique femoral fracture, with thickening of the lateral cortex. They underwent surgical treatment obtaining good functional and imaging result.Discussion: These cases fulfill the established criteria for atypical femoral fracture, thereby illustrating a serious adverse event of long-term treatment with bisphosphonates. Such relationship has still not been clearly established by scientific evidence. However, its effectiveness in preventing osteoporotic fractures is well proven.Conclusion: The atypical femoral fractures are possibly a serious adverse effect of the long-term treatment with bisphosphonates. Scientific evidence still supports its use, however, the physician must be aware of these events and closely follow-up these patients.

Osteoporosis

2018 ◽  
Author(s):  
Angela J. Shepherd ◽  
Juliet M. Mckee
Keyword(s):  
Osteoporotic Fractures ◽  
Standard Of Care ◽  
Osteoporosis Treatment ◽  
Term Treatment ◽  
Osteoporosis Prevention ◽  
Vitamin Intake ◽  
Long Term Treatment ◽  
Good Nutrition ◽  
Moderate Alcohol Intake

Osteoporotic fractures are major causes of suffering and death. Dual-energy x-ray absorptiometry (DEXA) is the standard of care for diagnosis (T-score ≤ –2.5) of osteoporosis. Prevention of fractures requires addressing bone and muscle strength and balance. Physical exercise, good nutrition (fruits, vegetables, adequate calcium), adequate vitamin intake (C, D, and K), tobacco cessation, and no more than moderate alcohol intake enhance bone health and decrease fracture risk. Long-term treatment with glucocorticoids, certain drugs used in breast or prostate cancer treatment, and proton pump inhibitors used for gastroesophageal reflux disease may increase the risk for osteoporosis. Pharmacologically, bisphosphonates are the mainstay of osteoporosis treatment.

Long-Term Management of Generalized Pustular Psoriasis with Infliximab: Case Series

2008 ◽  
Vol 12 (4) ◽  
pp. 184-188 ◽  
Author(s):  
Shannon B. Routhouska ◽  
Pranav B. Sheth ◽  
Neil J. Korman
Keyword(s):  
Case Reports ◽  
Case Series ◽  
Term Treatment ◽  
Pustular Psoriasis ◽  
Short Term Treatment ◽  
Long Term Treatment ◽  
Generalized Pustular Psoriasis ◽  
Factor Α ◽  
Term Management

Background: Infliximab, a tumor necrosis factor α antagonist, has recently been shown to be successful for the short-term treatment of generalized pustular psoriasis (GPP) in multiple case reports. Objective: The goal of this case series was to assess the efficacy of the longer-term management of GPP with infliximab. Methods: Three patients with severe GPP were followed to assess the efficacy of long-term treatment with infliximab. Results: Infliximab therapy was more efficacious with infusion every 6 to 8 weeks in combination with methotrexate. Conclusion: Infliximab may be efficacious for some patients for the long-term management of GPP. Maintaining a strict infliximab infusion schedule and concomitant methotrexate therapy may decrease infusion reactions and increase efficacy.

scholarly journals Is there a familial predisposition to bisphosphonate-induced atypical femoral fractures?

2021 ◽  
Vol 67 (3) ◽  
pp. 370-373
Author(s):  
Mehmet Okçu ◽  
Fatmanur Aybala Koçak ◽  
Samet Sancar Kaya ◽  
Figen Tuncay
Keyword(s):  
Adverse Effect ◽  
Bone Turnover ◽  
Bone Quality ◽  
Genetic Factors ◽  
Femoral Fractures ◽  
Osteoporosis Treatment ◽  
Atypical Femoral Fractures ◽  
Treatment Of Osteoporosis ◽  
Familial Predisposition ◽  
Short Period

Bisphosphonates are commonly used in the treatment of osteoporosis. Atypical femoral fracture (AFF) is a well-known adverse effect of bisphosphonate use. The importance of genetic factors has been demonstrated in bone quality, bone turnover, and in the response to osteoporosis treatment. Herein, we present two cases of bilateral AFFs after bisphosphonate use for a short period of time in members of the same family (mother and her daughter) and discuss genetic predisposition to bisphosphonate-induced AFFs in the light of literature data.

Long-Term Treatment of Patients with Recurrent Unipolar Major Depression: Evidence to Clinical Practice

CNS Spectrums ◽  
2006 ◽  
Vol 11 (S15) ◽  
pp. 4-5 ◽  
Author(s):  
Martin B. Keller
Keyword(s):  
Treatment Strategies ◽  
Patient Characteristics ◽  
Evidence Base ◽  
Term Treatment ◽  
Recurrent Depression ◽  
Long Term Treatment ◽  
Risk Factors For Recurrence ◽  
The Individual ◽  
Term Management

Major depressive disorder (MDD) is almost exclusively recurrent. The vast majority of patients who experience one episode of MDD will eventually experience at least one more episode during their lifetime. The recurrent nature of MDD increases the burden to both the individual and society. Hence, it is imperative that treatment strategies focus on achieving remission acutely, as well as maintaining of remission and preventing recurrence. The articles in this supplement are based on presentations and a dialogue among a group of experts who convened for a roundtable discussion on improving long-term outcomes with antidepressant therapy.Improving long-term treatment of MDD begins with understanding the clinical course of recurrent depression and the ability to recognize those patients who are at greatest risk for recurrence. James H. Kocsis, MD, reviews the course of recurrent depression, emphasizing the tendency for it to progressively worsen. He also discusses patient characteristics and other risk factors for recurrence as well as current recommendations for long-term management of recurrent depression.Although long-term antidepressant maintenance treatment studies are somewhat limited in number, they provide the evidence base that shapes existing guidelines for long-term management of recurrent depression. Michael E. Thase, MD, examines this evidence for the different classes of antidepressants. In addition, Thase reviews evidence for the efficacy of psychotherapy and discusses its potentially important role in long-term depression management.

Sign in / Sign up

Export Citation Format

Share Document