Bilateral Atypical Femoral Fractures after Prolonged Bisphosphonate Therapy: A Case Report and New Approach to the Management of Iatrogenic Fractures

Joseph Maalouly M.D; Dany Aouad M.D; Murielle Feghaly; Cynthia Habib; Georges El- Rassi M.D

Authors

Joseph Maalouly M.D
Dany Aouad M.D
Murielle Feghaly
Cynthia Habib
Georges El- Rassi M.D

Keywords:

atypical femoral fractures, bisphosphonate, alendronate, ibandronate, osteoporosis

Abstract

Atypical femoral fractures (AFFs) are defined as atraumatic fractures of the femoral diaphysis and are known to be a complication of prolonged bisphosphonate (BP) therapy. Surgical treatment of AFFs consists of intramedullary (IM) nailing. We report the case of a 58year-old female patient who presented with bilateral femoral fractures after 12 years of BP therapy. Surgical management using IM nails resulted in iatrogenic fractures of the femoral shaft in both limbs. We therefore, opted for conservative treatment, where a non-weight bearing protocol was implemented. Healing was then observed after six months of follow-up.

Downloads

How to Cite

Bilateral Atypical Femoral Fractures after Prolonged Bisphosphonate Therapy: A Case Report and New Approach to the Management of Iatrogenic Fractures. (2019). Global Journal of Medical Research, 19(H2), 21-26. https://medicalresearchjournal.org/index.php/GJMR/article/view/1758

Download Citation

References

Kuntheavy Ing-Lorenzini, Jules Desmeules, Olivier Plachta, Domizio Suva, Pierre Dayer, Robin Peter (2009) Low-Energy Femoral Fractures Associated with the Long-Term Use of Bisphosphonates. 32(9), 775-785.

Arkan Sayed-Noor, Göran Sjödén (2009) Case Reports: Two Femoral Insufficiency Fractures after Long-term Alendronate Therapy. 467(7), 1921-1926.

Craig Capeci, Nirmal Tejwani (2009) Bilateral Low-Energy Simultaneous or Sequential Femoral Fractures in Patients on Long-Term Alendronate Therapy. 91(11), 2556-2561.

E Shane, D Burr, P Ebeling (2010) Atypical subtrochanteric and diaphyseal femoral fractures: report of a task force of the American Society for Bone. 25, 2267-2294.

E Shane, D Burr, B Abrahamsen (2014) Atypical subtrochanteric and diaphyseal femoral fractures: Second report of a task force of the American Society for Bone and Mineral Research. 29(1), 1-23.

Brett Rocos, Thomas Fleming, Karen Harding, Mehool Acharya, Andrew Riddick, Mike Kelly (2018) A Case Series and Discussion on Surgical Treatment Strategy for Atypical Proximal Femoral Fractures Associated with Bisphosphonate Use. 10(12), 3670.

S Das De, T Setiobudi, L Shen, S Das De (2010) A rational approach to management of alendronate-related subtrochanteric fractures. 92-B(5), 679-686.

Yoram Weil, Gurion Rivkin, Ori Safran, Meir Liebergall, A Foldes (2011) The Outcome of Surgically Treated Femur Fractures Associated With Long-Term Bisphosphonate Use. 71(1), 186-190.

Kenneth Egol, Ji Park, Zehava Rosenberg, Valerie Peck, Nirmal Tejwani (2013) Healing Delayed But Generally Reliable After Bisphosphonate-associated Complete Femur Fractures Treated with IM Nails. 472(9), 2728-2734.

B Teo, J Koh, S Goh, M Png, D Chua, T Howe (2014) Post-operative outcomes of atypical femoral subtrochanteric fracture in patients on bisphosphonate therapy. 96-B(5), 658-664.

H Fleish, R Russell, M Francis (1969) Diphosphonates inhibit hydroxyapatite dissolution in vitro and bone resorption in tissue culture and in vivo. 165, 1262-1264.

M Sato, W Grasser, N Endo, R Akins, H Simmons, D Thompson, E Golub, G Rodan (1991) Bisphosphonate action. Alendronate localization in rat bone and effects on osteoclast ultrastructure.. 88(6), 2095-2105.

M Schaffler, K Choi, C Milgrom (1995) Aging and matrix microdamage accumulation in human compact bone. 17, 521-525.

Erich Durchschlag, Eleftherios Paschalis, Ruth Zoehrer, Paul Roschger, Peter Fratzl, Robert Recker, Roger Phipps, Klaus Klaushofer (2006) Bone Material Properties in Trabecular Bone From Human Iliac Crest Biopsies After 3- and 5-Year Treatment With Risedronate. 21(10), 1581-1590.

G Boivin, P Chavassieux, A Santora, J Yates, P Meunier (2000) Alendronate increases bone strength by increasing the mean degree of mineralization of bone tissue in osteoporotic women. 27(5), 687-694.

P Roschger, E Paschalis, P Fratzl, K Klaushofer (2008) Bone mineralization density distribution in health and disease. 42(3), 456-466.

N Kharwadkar, B Mayne, J Lawrence, V Khanduja (2017) Bisphosphonates and atypical subtrochanteric fractures of the femur. 6(3), 144-153.

K-J Lee, J Yoo, K-J Oh (2017) Surgical outcome of intramedullary nailing in patients with complete atypical femoral fracture: a multicenter retrospective study. 48, 941-945.

Yongping Cao, Satoshi Mori, Tasuku Mashiba, Michael Westmore, Linda Ma, Masahiko Sato, Tomoyuki Akiyama, Liping Shi, Satoshi Komatsubara, Kensaku Miyamoto, Hiromichi Norimatsu (2002) Raloxifene, Estrogen, and Alendronate Affect the Processes of Fracture Repair Differently in Ovariectomized Rats. 17(12), 2237-2246.

R Thompson, J Phillips, S Mccauley, J Elliott, C Moran (2012) Atypical femoral fractures and bisphosphonate treatment. 94-B(3), 385-390.