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Open Access 01-12-2019 | Femoral Fracture | Research article

Atypical femoral fracture in patients with bone metastasis receiving denosumab therapy: a retrospective study and systematic review

Authors: Momoko Takahashi, Yukinori Ozaki, Rika Kizawa, Jun Masuda, Kentaro Sakamaki, Keiichi Kinowaki, Taro Umezu, Chihiro Kondoh, Yuko Tanabe, Nobuko Tamura, Yuji Miura, Takashi Shigekawa, Hidetaka Kawabata, Noriyuki Baba, Haruo Iguchi, Toshimi Takano

Published in: BMC Cancer | Issue 1/2019

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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Title: Atypical femoral fracture in patients with bone metastasis receiving denosumab therapy: a retrospective study and systematic review
Authors: Momoko Takahashi
Yukinori Ozaki
Rika Kizawa
Jun Masuda
Kentaro Sakamaki
Keiichi Kinowaki
Taro Umezu
Chihiro Kondoh
Yuko Tanabe
Nobuko Tamura
Yuji Miura
Takashi Shigekawa
Hidetaka Kawabata
Noriyuki Baba
Haruo Iguchi
Toshimi Takano
Publication date: 01-12-2019
Publisher: BioMed Central
Keywords: Femoral Fracture
Bisphosphonate
Bone Metastasis
Denosumab
Denosumab
Zoledronic Acid
Published in: BMC Cancer / Issue 1/2019
Electronic ISSN: 1471-2407
DOI: https://doi.org/10.1186/s12885-019-6236-6

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