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Published in: Skeletal Radiology 5/2016

01-05-2016 | Scientific Article

Long-term radiographic follow-up of bisphosphonate-associated atypical femur fractures

Authors: Jennifer L. Favinger, Daniel Hippe, Alice S. Ha

Published in: Skeletal Radiology | Issue 5/2016

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Abstract

Objective

To evaluate the appearance of bisphosphonate-related femur insufficiency fractures on long-term follow-up radiographic studies and to describe the rate of fracture line obscuration and cortical beak healing over time.

Materials and methods

In this retrospective study, bisphosphonate-related femur fracture radiographs were reviewed by two radiologists for the presence of a fracture line, callus, and the characteristic cortical beak. Kaplan–Meier curves were used to analyze the time to first indication of healing. Femurs were also subdivided into those who underwent early versus late surgical fixation and those who underwent early versus late discontinuation of bisphosphonate. Clinical data including pain level and medication history were collected.

Results

Forty-seven femurs with a bisphosphonate-related femur fracture were identified in 28 women. Eighty-five percent took a bisphosphonate for greater than 5 years and 59 % for greater than 10 years. The median time to beak healing was 265 weeks and the median time to fracture line healing was 56 weeks in the 31 femurs with a baseline fracture. No statistically significant difference was identified between surgical fixation and conservative management.

Conclusions

Bisphosphonate-related fractures demonstrate notably prolonged healing time on long-term follow-up.
Literature
1.
go back to reference Einhorn TA, Bogdan Y, Tornetta P. Bisphosphonate-associated fractures of the femur: pathophysiology and treatment. J Orthop Trauma. 2014;28(7):433–8.CrossRefPubMed Einhorn TA, Bogdan Y, Tornetta P. Bisphosphonate-associated fractures of the femur: pathophysiology and treatment. J Orthop Trauma. 2014;28(7):433–8.CrossRefPubMed
2.
go back to reference Park-Wyllie LY, Mamdani MM, Juurlink DN, et al. Bisphosphonate use and the risk of subtrochanteric or femoral shaft fractures in older women. JAMA. 2011;305(8):783–9.CrossRefPubMed Park-Wyllie LY, Mamdani MM, Juurlink DN, et al. Bisphosphonate use and the risk of subtrochanteric or femoral shaft fractures in older women. JAMA. 2011;305(8):783–9.CrossRefPubMed
3.
go back to reference Porrino Jr JA, Kohl CA, Taljanovic M, Rogers LF. Diagnosis of proximal femoral insufficiency fractures in patients receiving bisphosphonate therapy. Am J Roentgenol. 2010;194:1061–4.CrossRef Porrino Jr JA, Kohl CA, Taljanovic M, Rogers LF. Diagnosis of proximal femoral insufficiency fractures in patients receiving bisphosphonate therapy. Am J Roentgenol. 2010;194:1061–4.CrossRef
4.
go back to reference Gedmintas L, Solomon DH, Kim SC. Bisphosphonates and risk of subtrochanteric, femoral shaft, and atypical femur fracture: a systemic review and meta-analysis. J Bone Miner Res. 2013;28(8):1729–37.CrossRefPubMedPubMedCentral Gedmintas L, Solomon DH, Kim SC. Bisphosphonates and risk of subtrochanteric, femoral shaft, and atypical femur fracture: a systemic review and meta-analysis. J Bone Miner Res. 2013;28(8):1729–37.CrossRefPubMedPubMedCentral
5.
go back to reference Khan SA, Kanis JA, Vasikaran S, et al. Elimination and biochemical response to intravenous alendronate in postmenopausal osteoporosis. J Bone Miner Res. 1997;12(10):1700–7.CrossRefPubMed Khan SA, Kanis JA, Vasikaran S, et al. Elimination and biochemical response to intravenous alendronate in postmenopausal osteoporosis. J Bone Miner Res. 1997;12(10):1700–7.CrossRefPubMed
6.
go back to reference Schilcher J, Koeppen V, Aspenberg P, Michaëlsson K. Risk of atypical femoral fracture during and after bisphosphonate use: full report of a nationwide study. Acta Orthop. 2015;86(1):100–7.CrossRefPubMedPubMedCentral Schilcher J, Koeppen V, Aspenberg P, Michaëlsson K. Risk of atypical femoral fracture during and after bisphosphonate use: full report of a nationwide study. Acta Orthop. 2015;86(1):100–7.CrossRefPubMedPubMedCentral
7.
go back to reference Schilcher J, Koeppen V, Aspenberg P, Michaëlsson K. Risk of atypical femoral fracture during and after bisphosphonate use. N Engl J Med. 2014;371(10):974–6.CrossRefPubMed Schilcher J, Koeppen V, Aspenberg P, Michaëlsson K. Risk of atypical femoral fracture during and after bisphosphonate use. N Engl J Med. 2014;371(10):974–6.CrossRefPubMed
8.
go back to reference Turnbull BW. Nonparametric estimation of a survivorship function with doubly censored data. J Am Stat. 1974;69(345):169–73.CrossRef Turnbull BW. Nonparametric estimation of a survivorship function with doubly censored data. J Am Stat. 1974;69(345):169–73.CrossRef
9.
go back to reference Kalbfleisch JD, Prentice RL. The statistical analysis of failure time data. 2nd ed. Hoboken: John Wiley & Sons; 2011. Kalbfleisch JD, Prentice RL. The statistical analysis of failure time data. 2nd ed. Hoboken: John Wiley & Sons; 2011.
10.
go back to reference Diggle P, Heagerty P, Liang K-Y, Zeger S. Analysis of longitudinal data. Oxford: University Press; 2002. 396 pp. Diggle P, Heagerty P, Liang K-Y, Zeger S. Analysis of longitudinal data. Oxford: University Press; 2002. 396 pp.
11.
go back to reference Dijkman BG, Sprague S, Schemitsch EH, Bhandari M. When is a fracture healed? Radiographic and clinical criteria revisited. J Orthop Trauma. 2010;24 Suppl 1:S76–80.CrossRefPubMed Dijkman BG, Sprague S, Schemitsch EH, Bhandari M. When is a fracture healed? Radiographic and clinical criteria revisited. J Orthop Trauma. 2010;24 Suppl 1:S76–80.CrossRefPubMed
12.
go back to reference Corrales LA, Morshed S, Bhandari M, Miclau T. Variability in assessment of fracture-healing in orthopedic trauma studies. J Bone Joint Surg Am. 2008;90(9):1862–8.CrossRefPubMedPubMedCentral Corrales LA, Morshed S, Bhandari M, Miclau T. Variability in assessment of fracture-healing in orthopedic trauma studies. J Bone Joint Surg Am. 2008;90(9):1862–8.CrossRefPubMedPubMedCentral
13.
go back to reference Browner BD, Jupiter JB, Levin AM, Trafton PG, Krettek C. Skeletal trauma: basic science, management and reconstruction. Philadelphia: Saunders Elsevier; 2009. Browner BD, Jupiter JB, Levin AM, Trafton PG, Krettek C. Skeletal trauma: basic science, management and reconstruction. Philadelphia: Saunders Elsevier; 2009.
14.
go back to reference Nikolaou VS, Efstathopoulos N, Kontakis G, Kanakaris NK, Giannoudis PV. The influence of osteoporosis in femoral fracture healing time. Injury. 2009;40(6):663–8.CrossRefPubMed Nikolaou VS, Efstathopoulos N, Kontakis G, Kanakaris NK, Giannoudis PV. The influence of osteoporosis in femoral fracture healing time. Injury. 2009;40(6):663–8.CrossRefPubMed
16.
go back to reference Vigorita VJ, Silver JS, Eisemon EO. Osteoclast abnormalities in fractured bone during bisphosphonate treatment for osteoporosis: a case report. Skelet Radiol. 2012;41(7):861–5.CrossRef Vigorita VJ, Silver JS, Eisemon EO. Osteoclast abnormalities in fractured bone during bisphosphonate treatment for osteoporosis: a case report. Skelet Radiol. 2012;41(7):861–5.CrossRef
17.
go back to reference Molvik H, Khan W. Bisphosphonates and their influence on fracture healing: a systematic review. Osteoporos Int. 2015;26:1251–60.CrossRefPubMed Molvik H, Khan W. Bisphosphonates and their influence on fracture healing: a systematic review. Osteoporos Int. 2015;26:1251–60.CrossRefPubMed
18.
go back to reference Banffy MB, Vrahas MS, Ready JE, Abraham JA. Nonoperative versus prophylactic treatment of bisphosphonate-associated femoral stress fractures. Clin Orthop Relat Res. 2011;469(7):2028–34.CrossRefPubMedPubMedCentral Banffy MB, Vrahas MS, Ready JE, Abraham JA. Nonoperative versus prophylactic treatment of bisphosphonate-associated femoral stress fractures. Clin Orthop Relat Res. 2011;469(7):2028–34.CrossRefPubMedPubMedCentral
19.
go back to reference Egol KA, Park JH, Prensky C, Rosenberg ZS, Peck V, Tejwani NC. Surgical treatment improves clinical and functional outcomes for patients who sustain incomplete bisphosphonate-related femur fractures. J Orthop Trauma. 2013;27(6):331–5.CrossRefPubMed Egol KA, Park JH, Prensky C, Rosenberg ZS, Peck V, Tejwani NC. Surgical treatment improves clinical and functional outcomes for patients who sustain incomplete bisphosphonate-related femur fractures. J Orthop Trauma. 2013;27(6):331–5.CrossRefPubMed
20.
go back to reference Egol KA, Park JH, Rosenberg ZS, Peck V, Tejwani NC. Healing delayed but generally reliable after bisphosphonate-associated complete femur fractures treated with IM nails. Clin Orthop Relat Res. 2014;472(9):2728–34.CrossRefPubMedPubMedCentral Egol KA, Park JH, Rosenberg ZS, Peck V, Tejwani NC. Healing delayed but generally reliable after bisphosphonate-associated complete femur fractures treated with IM nails. Clin Orthop Relat Res. 2014;472(9):2728–34.CrossRefPubMedPubMedCentral
21.
go back to reference Miyakoshi N, Aizawa T, Saski S, et al. Healing of bisphosphonate-associated atypical femoral fractures in patients with osteoporosis: a comparison between treatment with and without teriparatide. J Bone Miner Metab. 2015;33(5):553–9.CrossRefPubMed Miyakoshi N, Aizawa T, Saski S, et al. Healing of bisphosphonate-associated atypical femoral fractures in patients with osteoporosis: a comparison between treatment with and without teriparatide. J Bone Miner Metab. 2015;33(5):553–9.CrossRefPubMed
22.
go back to reference Zhang D, Potty A, Vyas P, Lane J. The role of recombinant PTH in human fracture healing: a systematic review. J Orthop Trauma. 2014;28(1):57–62.CrossRefPubMed Zhang D, Potty A, Vyas P, Lane J. The role of recombinant PTH in human fracture healing: a systematic review. J Orthop Trauma. 2014;28(1):57–62.CrossRefPubMed
23.
go back to reference Chiang CY, Zebaze RMD, Ghasem-Zadeh A, et al. Teriparatide improves bone quality and healing of atypical femoral fractures associated with bisphosphonate therapy. Bone. 2013;52(1):360–5.CrossRefPubMed Chiang CY, Zebaze RMD, Ghasem-Zadeh A, et al. Teriparatide improves bone quality and healing of atypical femoral fractures associated with bisphosphonate therapy. Bone. 2013;52(1):360–5.CrossRefPubMed
Metadata
Title
Long-term radiographic follow-up of bisphosphonate-associated atypical femur fractures
Authors
Jennifer L. Favinger
Daniel Hippe
Alice S. Ha
Publication date
01-05-2016
Publisher
Springer Berlin Heidelberg
Published in
Skeletal Radiology / Issue 5/2016
Print ISSN: 0364-2348
Electronic ISSN: 1432-2161
DOI
https://doi.org/10.1007/s00256-016-2346-2

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