A Case of an Atypical Femoral Fracture Related to Long-term Use of Bisphosphonate for Bone Metastasis of Breast Cancer

Abstract Background While denosumab has been shown to prevent skeletal-related events in patients with bone metastasis, there is a concern that it may cause atypical femoral fracture (AFF). While AFF has been reported in patients with osteoporosis receiving denosumab, data are scarce in the context of AFF occurring in patients with bone metastasis receiving monthly denosumab therapy. Methods To analyze the incidence of AFF in patients with bone metastasis, we reviewed the medical records of patients who had received monthly denosumab (120 mg) treatment from May 2012 to June 2017 at any of the three participant institutions. Results The study population consisted of 277 patients who had received a median of 10 doses (range, 1–79) of denosumab. Five patients were diagnosed as having AFF or symptomatic atypical femoral stress reaction (AFSR) needing surgical intervention, representing an incidence rate of 1.8% (95% confidence interval, 0.77–4.2). These patients had received 15, 45, 45, 46 or 47 doses of denosumab, respectively. Four of the patients had received prior zoledronic acid treatment. The results of our analysis suggested that long-term use of denosumab, especially for more than 3.5 years, and prior use of zoledronic acid were risk factors for the development of AFF. Conclusions We found the AFF events in 5 patients (1.8%) among 277 cancer patients who had received monthly denosumab (120 mg) treatment. Long-term denosumab treatment and prior zoledronic acid treatment were identified as risk factors for the development of AFF.

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Atypical Femoral Fracture in a Patient with Metastatic Breast Cancer During Denosumab Therapy

Journal of Clinical Case Reports ◽

10.4172/2165-7920.1000737 ◽

2016 ◽

Vol 06 (03) ◽

Author(s):

Kazuhiro Ohnaru

Keyword(s):

Breast Cancer ◽

Metastatic Breast Cancer ◽

Femoral Fracture ◽

Metastatic Breast ◽

Atypical Femoral Fracture

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Atypical periprosthetic femoral fracture associated with long-term bisphosphonate therapy

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-020-01941-x ◽

2020 ◽

Vol 15 (1) ◽

Author(s):

Dávid Dózsai ◽

Tamás Ecseri ◽

István Csonka ◽

István Gárgyán ◽

Péter Doró ◽

...

Keyword(s):

Femoral Fracture ◽

Case Reports ◽

Femoral Stem ◽

Femoral Fractures ◽

Atypical Femoral Fracture ◽

Periprosthetic Fractures ◽

Periprosthetic Femoral Fracture ◽

Mineral Research ◽

Periprosthetic Femoral Fractures

Abstract Background Atypical femoral fracture is one of the many complications after the long-term use of bisphosphonates. The American Society for Bone and Mineral Research has officially excluded periprosthetic femoral fractures (PFFs) from the definition of atypical femoral fractures (AFFs). Several case reports found that PFFs can occur with characteristics similar to those of AFFs. The purpose of our study was to evaluate the proportion of atypical fractures among Vancouver type B1 fractures, and to determine the association between the long-term use of bisphosphonates and the occurrence of atypical periprosthetic femoral fractures (APFFs). Methods In this retrospective study, we reviewed 41 patients with Vancouver type B1 periprosthetic fractures between January 1, 2011 and December 31, 2018. We classified them into two groups, namely atypical and typical PFFs, based on the fracture morphology. We noted the proportion of atypical periprosthetic fractures among B1 fractures and identified risk factors. Results Among the 41 PFFs, 5 (13%) fractures were classified as atypical PFF based on the radiological characteristics. The longer duration of bisphosphonate use was probably the only independent risk factor that significantly increases the occurrence of APFF (p = 0.03, 0.08 (CI 0.008 – 0.16)). There were no significant differences in age, gender, body mass index, comorbidities, corticosteroid use, positioning of the femoral stem, the method of fixation (cemented or cementless) and time lapse from before the primary prosthesis implantation to the PFF in the development of atypical fracture type. Conclusions There seems to be a correlation between the long-term intake of bisphosphonates and the atypical periprosthetic fracture. Atypical femoral fracture can also occur in the periprosthetic form. Trial registration Study number: 22/2019-SZTE, http://www.klinikaikutatas.hu/hu/kutatasetika/jovahagyott-vizsgalatok-koezerdeku-adatai/category/25-jovahagyott-vizsgalatok-kozerdeku-adatai-rkeb-2019.html?download=985:22-2019.

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