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

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.

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

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.

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.

scholarly journals Long-term risks of bisphosphonate therapy

2014 ◽  
Vol 58 (5) ◽  
pp. 523-529 ◽  
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.

scholarly journals Effect of Early Initiation of Combination Therapy of Anti-Inflammatory and Anti-Fibrotic Drugs on Post COVID-19 Interstitial Lung Disease: A Case Report

2021 ◽  
Vol 7 (3) ◽  
Keyword(s):  
Case Report ◽  
Interstitial Lung Disease ◽  
Lung Disease ◽  
Oral Prednisone ◽  
Evidence Based ◽  
Limited Evidence ◽  
Anti Inflammatory ◽  
Short Time

The persistence of lung parenchymal changes Post COVID-19 is increasingly recognized as a vital outcome observed on some patients recovering from SARS-CoV2 infection with limited evidence-based management so far. Here we present a 64-year-old male developed extensive interstitial lung changes post SARS-CoV2 infection and was successfully managed with oral prednisone, pirfenidone, and azithromycin maintenance regimen with significant improvement in his clinical and radiographic parameters noted within a relatively short time. The role of a combined therapeutic approach with anti-inflammatory and anti-fibrotic drugs might be provocative action in patients with COVID-19 related interstitial lung disease, especially those at risk for persistent long-term abnormalities and pulmonary fibrosis development.

scholarly journals Adjunctive Physiotherapy – A Case Report on the Management and Effective Treatment of Diabetic Neuropathic Foot Ulcer Using Adjunctive Physiotherapy

2021 ◽  
Vol 20 (5) ◽  
pp. 81-84
Author(s):  
M. Colpin
Keyword(s):  
Case Report ◽  
Historical Context ◽  
Foot Ulcer ◽  
Intervention Context ◽  
Rehabilitation Facilities ◽  
Foundational Work ◽  
Neuropathic Foot ◽  
Primary Management

Physiotherapy must be considered and reprioritized as an adjunctive medical service for long term health and rehabilitation. Comprehensive physiotherapy has the potential to be administered in out-patient rehabilitation facilities, hospitals, and Thermal Health Centers. A review of select adjunctive physiotherapy methods will be presented along with a case report of the successful treatment, with rationally selected physiotherapeutic agents, of a Diabetic Neuropathic Foot Ulcer scheduled for surgical amputation. By highlighting this case, the author is attempting to bring attention to familiar and time-tested therapies that have fallen out of use in a primary intervention context. This case report aims to exemplify that the role for rational physiotherapeutic methods stretches beyond current mainstream applications. Historical Context. Will supply the historical and foundational work in the field of physiotherapy that contextualizes the rational basis for the applications described in the case. Therapies. Lists the physiotherapy methods highlighted in this case, reviews the mechanism of action, discusses the therapeutic application, and provides modern citation for the rationalization of the therapy. Case Report. Reviews a detailed narrative of the case in review. Covers intake, case history, progression of case, as well as clinical applications for physiotherapy as they arise in the course of case management. Conclusion. Reviews the emphasis for reconsidering the role of Physiotherapy in the primary management of acute and chronic illness.

scholarly journals Atypical femur fractures: current understanding and approach to management

2020 ◽  
Vol 12 ◽  
pp. 1759720X2091698
Author(s):  
Lianne Tile ◽  
Angela M. Cheung
Keyword(s):  
Medical Therapy ◽  
Clinical Decision Making ◽  
Osteoporotic Fractures ◽  
Osteoporosis Treatment ◽  
Clinical Decision ◽  
Current Understanding ◽  
Rare Type ◽  
Femur Fractures ◽  
Atypical Femur Fractures

Osteoporosis and resulting osteoporotic fractures are responsible for significant morbidity, excess mortality, and health care costs in the developed world. Medical therapy for osteoporosis has been shown in multiple randomized controlled trials to reduce the risk of vertebral and non-vertebral fractures and hip fractures, and in some studies bisphosphonate medications have been associated with improved survival. Although the overall benefit to risk ratio of osteoporosis medications remains favorable, there have been concerns raised about the long-term safety of these treatments. Atypical femur fracture, which is a rare type of fracture that has been associated with the long-term use of potent antiresorptive bone medications, is a potentially devastating consequence of osteoporosis treatment. This paper reviews our current understanding of atypical femur fractures, their relationship to antiresorptive osteoporosis medications, and proposed strategies for management, in order to inform clinical decision making about the optimal use and duration of medical therapy for the treatment of patients with osteoporosis or at high risk for osteoporotic fractures.

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