scholarly journals Case Report: Prophylactic Plate Fixation for Incomplete Atypical Ulnar Fractures Resulting From the Use of Denosumab for Bone Metastases

2022 ◽  
Vol 12 ◽  
Author(s):  
Atsuro Murai ◽  
Kaoru Tada ◽  
Tadahiro Nakajima ◽  
Mika Akahane ◽  
Masashi Matsuta ◽  
...  
Keyword(s):  
Bone Resorption ◽  
Bone Metastases ◽  
Plate Fixation ◽  
Femoral Fractures ◽  
Prophylactic Surgery ◽  
Atypical Femoral Fractures ◽  
Metastatic Lesions ◽  
Ulna Fractures ◽  
Inhibitor Treatment

Patients with bone metastases are treated with long-term bone resorption inhibitors such as bisphosphonates and denosumab. However, resorption inhibitors have been known to cause fractures, such as atypical femoral fractures (AFFs). In recent years, there have been an increasing number of reports of atypical ulna fractures (AUFs) caused by bone resorption inhibitor usage. Treatment of AUFs is complicated, especially when they occur in patients with bone metastases, because it is difficult to discontinue bone resorption inhibitor treatment without the risk of aggravating metastatic lesions. Prophylactic surgery is recommended in AFFs when fractures are predicted, but there are few reports of prophylactic surgery for AUFs. Here, we report a case of incomplete AUF in a 74-year-old woman which was surgically treated with prophylactic plate fixation. The patient had been using denosumab for 6 years to treat bone metastases due to thyroid cancer. After surgery, no fractures were observed for 2 years without discontinuing denosumab, and her forearm function was adequate. AUFs are rare and difficult to treat, so oncologists who treat bone metastases need to pay special attention to diagnose this incomplete AUF before the fracture worsens. We believe that detection of a possible fracture and prophylactic surgery can improve prognosis.

Mid-term outcomes after the surgical treatment of atypical femoral fractures

2021 ◽  
Vol 103-B (11) ◽  
pp. 1648-1655
Author(s):  
Soo-Young Jeong ◽  
Kyu-Tae Hwang ◽  
Chang-Wug Oh ◽  
Joon-Woo Kim ◽  
Oog Jin Sohn ◽  
...  
Keyword(s):  
Plate Fixation ◽  
Femoral Fractures ◽  
Delayed Union ◽  
Fracture Site ◽  
High Grade ◽  
Atypical Femoral Fractures ◽  
Factors Affecting ◽  
The Mean

Aims The incidence of atypical femoral fractures (AFFs) continues to increase. However, there are currently few long-term studies on the complications of AFFs and factors affecting them. Therefore, we attempted to investigate the outcomes, complications, and risk factors for complication through mid-term follow-up of more than three years. Methods From January 2003 to January 2016, 305 patients who underwent surgery for AFFs at six hospitals were enrolled. After exclusion, a total of 147 patients were included with a mean age of 71.6 years (48 to 89) and 146 of whom were female. We retrospectively evaluated medical records, and reviewed radiographs to investigate the fracture site, femur bowing angle, presence of delayed union or nonunion, contralateral AFFs, and peri-implant fracture. A statistical analysis was performed to identify the significance of associated factors. Results The mean follow-up period was 70.2 months (36 to 191). There were 146 AFFs (99.3%) in female patients and the mean age was 71.6 years (48 to 89). The AFFs were located in the subtrochanter and shaft in 52 cases (35.4%) and 95 (64.6%), respectively. The preoperative mean anterior/lateral femoral bowing angles were 10.5° (SD 5.7°)/6.1° (SD 6.2°). The postoperative mean anterior/lateral bowing values were changed by 8.7° (SD 5.4°)/4.6° (SD 5.9°). Bisphosphonates had been used contemporarily in 115 AFFs (78.2%) for a mean of 52.4 months (1 to 204; SD 45.5) preoperatively. Nailing was performed in 133 AFFs (90.5%), and union was obtained at a mean of 23.6 weeks (7 to 85). Delayed union occurred in 41 (27.9%), and nonunion occurred in 13 (8.8%). Contralateral AFF occurred in 79 patients (53.7%), and the use of a bisphosphonate significantly influenced the occurrence of contralateral AFFs (p = 0.019). Peri-implant fractures occurred in a total of 13 patients (8.8%), and a significant increase was observed in cases with plating (p = 0.021) and high grade of postoperative anterolateral bowing (p = 0.044). Conclusion The use of a bisphosphonate was found to be a risk factor for contralateral AFF, and high-grade postoperative anterolateral bowing and plate fixation significantly increased the occurrence of peri-implant fractures. Long-term follow-up studies on the bilaterality of AFFs and peri-implant fractures are warranted. Cite this article: Bone Joint J 2021;103-B(11):1648–1655.

scholarly journals Sequential treatment with teriparatide and strontium ranelate in a postmenopausal woman with atypical femoral fractures after long-term bisphosphonate administration

HORMONES ◽  
2013 ◽  
Vol 12 (4) ◽  
pp. 591-597 ◽  
Author(s):  
Kalliopi Lampropoulou-Adamidou ◽  
Symeon Tournis ◽  
Alexia Balanika ◽  
Ioulia Antoniou ◽  
Ioannis Stathopoulos ◽  
...  
Keyword(s):  
Postmenopausal Woman ◽  
Strontium Ranelate ◽  
Femoral Fractures ◽  
Sequential Treatment ◽  
Atypical Femoral Fractures

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.

Medication-Induced Musculoskeletal Changes

2019 ◽  
pp. 322-326
Author(s):  
Winnie A. Mar
Keyword(s):  
Musculoskeletal System ◽  
Gold Standard ◽  
Imaging Modality ◽  
Femoral Fractures ◽  
Osteonecrosis Of The Jaw ◽  
Bisphosphonate Therapy ◽  
Atypical Femoral Fractures ◽  
Osteoblastic Activity ◽  
Induced Changes

Chapter 117 discusses common medication-induced changes of the musculoskeletal system. The effect of corticosteroids on the musculoskeletal system, including osteoporosis and osteonecrosis, is discussed. Corticosteroids decrease osteoblastic activity, stimulate bone resorption, and decrease intestinal absorption of calcium. Complications of bisphosphonate therapy such as atypical femoral fractures and osteonecrosis of the jaw are reviewed. Myopathies and tendon pathologies are briefly discussed, as well as bony changes potentially seen with long-term voriconazole treatment. For osteoporosis, DXA scan is the gold standard, whereas radiography is usually the first imaging modality performed in patients on voriconazole therapy who present with pain.

Risk factors for development of atypical femoral fractures in patients on long-term oral bisphosphonate therapy

Bone ◽  
2013 ◽  
Vol 56 (2) ◽  
pp. 426-431 ◽  
Author(s):  
Paola Franceschetti ◽  
Marta Bondanelli ◽  
Gaetano Caruso ◽  
Maria Rosaria Ambrosio ◽  
Vincenzo Lorusso ◽  
...  
Keyword(s):  
Risk Factors ◽  
Femoral Fractures ◽  
Bisphosphonate Therapy ◽  
Atypical Femoral Fractures ◽  
Oral Bisphosphonate

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.

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