Untreated Atypical Left Femoral Shaft Fracture: A Case Report of Its Complication
DOI:
https://doi.org/10.38179/ijcr.v3i1.159Keywords:
Atypical femoral fracture, biphosphonate usage, complications, osteoporosis, elderly traumaAbstract
Background: Bisphosphonate therapy is used to manage osteoporosis and decrease the risk of vertebral and hip fractures. These drugs act by suppressing osteoclast activity by inducing the inhibition of bone resorption and increasing bone mineral density. It has been shown that long-term use of bisphosphonate is correlated to a higher incidence of atypical femoral fractures.
Case report: This is a case report of an 81-year-old female, on bisphosphonate therapy for 12 years and with chronic left thigh pain for two and a half years who developed an incomplete atypical left femur fracture. What’s special about this case is that the fracture was ignored and then progressed after three months into a complete displaced spiral fracture that required surgical fixation.
Conclusion: The benefits of bisphosphonate treatment in preventing osteoporotic fractures outweigh the risk of the occurrence of these atypical fractures. Orthopedic surgeons as well as primary care physicians must keep atypical fractures in their differential diagnosis in patients presenting with prodromal symptoms and who are on long-term bisphosphonate therapy
References
Tile L, Cheung AM. Atypical femur fractures: current understanding and approach to management. Ther Adv Musculoskelet Dis. 2020;12:1759720X20916983. PMID: 32913448. https://doi.org/10.1177/1759720x20916983
Reid IR. Bisphosphonates in the treatment of osteoporosis: a review of their contribution and controversies. Skeletal Radiol. 2011;40(9):1191-1196. PMID: 21847749.
Ma S, Goh EL, Jin A, et al. Long-term effects of bisphosphonate therapy: perforations, microcracks and mechanical properties. Sci Rep. 2017;7:43399. PMID: 28262693. https://doi.org/10.1038/srep4339
Maalouly J, Aouad D, Feghali M, Habib C, El-Rassi G. Bilateral Atypical Femoral Fractures after Prolonged Bisphosphonate Therapy: A Case Report and New Approach to the Management of Iatrogenic Fractures. Glob J Med Res. 2019;19(2):21-26. https://doi.org/10.34257/gjmrhvol19is2pg21
Adler RA, El-Hajj Fuleihan G, Bauer DC, et al. Managing Osteoporosis in Patients on Long-Term Bisphosphonate Treatment: Report of a Task Force of the American Society for Bone and Mineral Research [published correction appears in J Bone Miner Res. 2016 Oct;31(10 ):1910]. J Bone Miner Res. 2016;31(1):16-35. PMID: 26350171. https://doi.org/10.1002/jbmr.2708
Shane E, Burr D, Ebeling PR, et al. Atypical subtrochanteric and diaphyseal femoral fractures: report of a task force of the American Society for Bone and Mineral Research [published correction appears in J Bone Miner Res. 2011 Aug;26(8):1987]. J Bone Miner Res. 2010;25(11):2267-2294. PMID: 20842676. https://doi.org/10.1002/jbmr.253
Shane E, Burr D, Abrahamsen B, et al. Atypical subtrochanteric and diaphyseal femoral fractures: second report of a task force of the American Society for Bone and Mineral Research. J Bone Miner Res. 2014;29(1):1-23. PMID: 23712442. https://doi.org/10.1002/jbmr.1998
Lovy AJ, Patterson D, Skeeles L, et al. Atraumatic segmental atypical femur fracture secondary to bisphosphonate use: A case report. J Clin Orthop Trauma. 2017;8(Suppl 1):S67-S71. PMID: 28878545. https://doi.org/10.1016%2Fj.jcot.2017.03.005
Gopal GK, Tam KL, Krishnan SP, Maddern IL. Bisphosphonate-associated atypical subtrochanteric femur fractures in the older patient. N Z Med J. 2014;127(1389):81-85. PMID: 24548959
Bhadada SK, Sridhar S, Muthukrishnan J, et al. Predictors of atypical femoral fractures during long term bisphosphonate therapy: a case series & review of literature. Indian J Med Res. 2014;140(1):46-54. PMID: 25222777.
Black DM, Geiger EJ, Eastell R, et al. Atypical Femur Fracture Risk versus Fragility Fracture Prevention with Bisphosphonates. N Engl J Med. 2020;383(8):743-753. PMID: 32813950. https://doi.org/10.1056/nejmoa1916525
Khow KS, Shibu P, Yu SC, Chehade MJ, Visvanathan R. Epidemiology and Postoperative Outcomes of Atypical Femoral Fractures in Older Adults: A Systematic Review. J Nutr Health Aging. 2017;21(1):83-91. PMID: 27999854. https://doi.org/10.1007/s12603-015-0652-3
Odvina CV, Levy S, Rao S, Zerwekh JE, Rao DS. Unusual mid-shaft fractures during long-term bisphosphonate therapy. Clin Endocrinol (Oxf). 2010;72(2):161-168. PMID: 19302584. https://doi.org/10.1111/j.1365-2265.2009.03581.x
Phillips HK, Harrison SJ, Akrawi H, Sidhom SA. Retrospective review of patients with atypical bisphosphonate related proximal femoral fractures. Injury. 2017;48(6):1159-1164. PMID: 28410753. https://doi.org/10.1016/j.injury.2017.03.025
Visekruna M, Wilson D, McKiernan FE. Severely suppressed bone turnover and atypical skeletal fragility. J Clin Endocrinol Metab. 2008;93(8):2948-2952. https://doi.org/10.1210/jc.2007-2803
Odvina CV, Zerwekh JE, Rao DS, Maalouf N, Gottschalk FA, Pak CY. Severely suppressed bone turnover: a potential complication of alendronate therapy. J Clin Endocrinol Metab. 2005;90(3):1294-1301. PMID: 15598694. https://doi.org/10.1210/jc.2004-0952
Anagnostis P, Stevenson JC. Bisphosphonate drug holidays--when, why and for how long?. Climacteric. 2015;18 Suppl 2:32-38. PMID: 26507608. https://doi.org/10.3109/13697137.2015.1099092
Tins BJ, Garton M, Cassar-Pullicino VN, Tyrrell PN, Lalam R, Singh J. Stress fracture of the pelvis and lower limbs including atypical femoral fractures-a review. Insights Imaging. 2015;6(1):97-110. PMID: 25448537. https://doi.org/10.1007/s13244-014-0371-z
Black DM, Abrahamsen B, Bouxsein ML, Einhorn T, Napoli N. Atypical Femur Fractures: Review of Epidemiology, Relationship to Bisphosphonates, Prevention, and Clinical Management. Endocr Rev. 2019;40(2):333-368. PMID: 30169557. https://doi.org/10.1210/er.2018-00001
Koh A, Guerado E, Giannoudis PV. Atypical femoral fractures related to bisphosphonate treatment: issues and controversies related to their surgical management. Bone Joint J. 2017;99-B(3):295-302. PMID: 28249967. https://doi.org/10.1302/0301-620x.99b3.bjj-2016-0276.r2
Ha YC, Cho MR, Park KH, Kim SY, Koo KH. Is surgery necessary for femoral insufficiency fractures after long-term bisphosphonate therapy?. Clin Orthop Relat Res. 2010;468(12):3393-3398. PMID: 20865463. https://doi.org/10.1007/s11999-010-1583-2
Tang BM, Eslick GD, Nowson C, Smith C, Bensoussan A. Use of calcium or calcium in combination with vitamin D supplementation to prevent fractures and bone loss in people aged 50 years and older: a meta-analysis [published correction appears in Lancet. 2012 Sep 1;380(9844):806]. Lancet. 2007;370(9588):657-666. PMID: 17720017. https://doi.org/10.1016/s0140-6736(07)61342-7
Bischoff-Ferrari HA, Willett WC, Wong JB, Giovannucci E, Dietrich T, Dawson-Hughes B. Fracture prevention with vitamin D supplementation: a meta-analysis of randomized controlled trials. JAMA. 2005;293(18):2257-2264. PMID: 15886381. https://doi.org/10.1001/jama.293.18.2257
Blood T, Feller RJ, Cohen E, Born CT, Hayda R. Atypical Fractures of the Femur: Evaluation and Treatment. JBJS Rev. 2015;3(3):e1. PMID: 27490887. https://doi.org/10.2106/jbjs.rvw.n.00062
Capeci CM, Tejwani NC. Bilateral low-energy simultaneous or sequential femoral fractures in patients on long-term alendronate therapy. J Bone Joint Surg Am. 2009;91(11):2556-2561. https://doi.org/10.2106/jbjs.h.01774
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