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

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.

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

Acta Endocrinologica ◽

10.1530/eje-17-1002 ◽

2018 ◽

Vol 178 (3) ◽

pp. R81-R87 ◽

Cited By ~ 20

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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Abstract #524: Clinical Outcome and Trajectories of Bone Mineral Density and Bone Turnover Markers 5 years after Starting Strontium Ranelate in a Post Menopausal Women with Bilateral Atypical Femoral Fractures

Endocrine Practice ◽

10.1016/s1530-891x(20)42660-6 ◽

2015 ◽

Vol 21 ◽

pp. 110

Author(s):

Francisco Bandeira ◽

Leonardo Bandeira ◽

Paulo Vidal ◽

Maria Paula Bandeira ◽

Nara Crispim

Keyword(s):

Bone Mineral Density ◽

Clinical Outcome ◽

Bone Turnover ◽

Strontium Ranelate ◽

Femoral Fractures ◽

Mineral Density ◽

Atypical Femoral Fractures ◽

Menopausal Women ◽

Turnover Markers ◽

Post Menopausal

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Are the Atypical Femoral Fractures a problem in order to Osteoporosis Treatment?: Its Management and Consequences

Rheumatology Current Research ◽

10.4172/2161-1149.1000180 ◽

2015 ◽

Vol 05 (04) ◽

Author(s):

Paredes Carnero Xavier ◽

Fernandez Cebrian

Keyword(s):

Femoral Fractures ◽

Osteoporosis Treatment ◽

Atypical Femoral Fractures

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Faculty Opinions recommendation of Teriparatide improves bone quality and healing of atypical femoral fractures associated with bisphosphonate therapy.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.717963709.793465502 ◽

2012 ◽

Author(s):

Jon Tobias ◽

Sarah Hardcastle

Keyword(s):

Bone Quality ◽

Femoral Fractures ◽

Bisphosphonate Therapy ◽

Atypical Femoral Fractures

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¿Tardan más en consolidar las fracturas asociadas a bifosfonatos? [Is the time for consolidation of fractures associated with bisphosphonates higher?]

Revista de la Asociación Argentina de Ortopedia y Traumatología ◽

10.15417/issn.1852-7434.2019.84.4.917 ◽

2019 ◽

Vol 84 (4) ◽

pp. 320-327

Author(s):

Fernando Vanoli ◽

Luciano Gentile ◽

Alejandra Beatriz Juarez ◽

Marcos Sahid Eluani ◽

Ignacio Pioli ◽

...

Keyword(s):

Surgical Treatment ◽

Femoral Fractures ◽

Healing Time ◽

Low Energy ◽

Control Group ◽

Cephalomedullary Nail ◽

Atypical Femoral Fractures ◽

Treatment Of Osteoporosis ◽

Femur Fractures ◽

Atypical Femur Fractures

Introducción: Los bifosfonatos evolucionaron como el pilar para el tratamiento de la osteoporosis, reduciendo la incidencia de fracturas. Recientemente, varias publicaciones describieron la aparición de fracturas atípicas de fémur de baja energía asociadas con el uso de bifosfonatos. El objetivo de este estudio fue evaluar el tiempo promedio de consolidación de las fracturas atípicas de fémur asociadas al tratamiento con bifosfonatos comparado con el de un grupo de control. Materiales y Métodos: Se evaluó, en forma retrospectiva, a 34 mujeres (edad promedio 74 años) con fracturas atípicas; 16 de ellas habían recibido bifosfonatos, al menos, por cinco años. Fueron tratadas entre 2006 y 2017, y estabilizadas con un clavo cefalomedular. Este grupo fue comparado con un grupo de control de similares características. Resultados: Veintidós tenían fracturas subtrocantéricas y 12, diafisarias. El 14% de las que tomaron bifosfonatos y fueron operadas requirió una revisión frente al 5,5% del grupo de control. El tiempo promedio de consolidación fue mayor en las tratadas con bifosfonatos (8.5 vs. 6 meses), con una diferencia estadísticamente significativa (p <0,001).Conclusiones: El beneficio del tratamiento con bifosfonatos en la prevención de fracturas es superior al riesgo de fracturas atípicas; sin embargo, es importante evaluar la relación riesgo-beneficio en cada paciente al comienzo y durante el tratamiento, teniendo en cuenta que, pese a esto, el tiempo de curación es más largo. AbstractIntroduction: Bisphosphonates evolved as the mainstay for the treatment of osteoporosis, reducing the incidence of fractures. Recently, several publications described the occurrence of low-energy atypical femur fractures associated with the use of bisphosphonates. The objective of this work was to study the average time of consolidation of the atypical femoral fractures caused by the consumption of bisphosphonates compared with a control group.Materials and Methods: We retrospectively evaluated 34 patients with atypical femoral fractures of which 16 patients had undergone treatment with bisphosphonates for at least 5 years, treated between 2006 and 2017, and stabilized with a cephalomedullary nail, and were compared with a control group of similar characteristics.Results: All the patients were female. The average age was 74 years. 22 presented subtrochanteric fractures while 12 were diaphyseal. 14% of the subjects who took bisphosphonates and received surgical treatment, required a revision versus 5.5% of the control group. The average time of consolidation was higher in those treated with bisphosphonates (8.5 months vs. 6 months), this being statistically significant (p <0.001).Conclusions: The benefit of treatment with bisphosphonates in the prevention of fractures is greater than the risk of atypical fractures. However, it is important to evaluate the risk-benefit in each patient at the beginning and the duration of the treatment, taking into account that despite this, the healing time is longer.

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