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Atypical femur fracture

Tsutomu Sugihara, Mitsuru Koizumi, Keiko Hayakawa, Yoshinori Ito, Naohiro Sata
Atypical femoral fractures (AFFs) occur in both osteoporosis patients and cancer patients who receive long-term bisphosphonate treatment. Denosumab offers an alternative approach for the treatment of bone metastases. We describe a 59-year-old woman with a history of breast carcinoma and bone metastasis who was prescribed denosumab for 4 years. The patient had no history of any prior bisphosphonate use. Bone scintigraphy showed an abnormal uptake in the right femur, which was confirmed as an impending AFF or atypical femoral stress reaction...
March 7, 2018: Clinical Nuclear Medicine
John E Lawrence, Danish Saeed, Jonathan Bartlett, Andrew D Carrothers
We report the case of a 55-year-old woman who presented to the emergency department having woken from sleep with right sided thigh swelling. Pelvic radiographs revealed bilateral atypical subtrochanteric femoral fractures (ASFFs). In the two years leading up to this admission, the patient had experienced gradually increasing pain and weakness in her legs which had resulted in a decrease in her mobility from fully mobile to bed-bound. During this time a neurologist had organised a magnetic-resonance imaging (MRI) scan of the brain and spine which was normal...
September 2017: Clinical Cases in Mineral and Bone Metabolism
Francesca Marini, Maria Luisa Brandi
Hypophosphatasia (HPP) is a congenital, rare and heterogeneous bone disorder, characterized by a deficit of calcified tissue mineralization, leading to skeletal deformities and osteomalacia in adults, rickets in infants and children, and fragility fractures and premature loss of dentition in children and adults. The disease is caused by a reduced or absent expression and activity of the tissue non-specific alkaline phosphatase (TNSALP) enzyme, derived from inactivating mutations of the alkaline phosphatase (ALPL) gene...
September 2017: Clinical Cases in Mineral and Bone Metabolism
Robert A Adler
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...
March 2018: European Journal of Endocrinology
Mohammad Al-Ashqar, Michalis Panteli, Gautam Chakrabarty, Peter V Giannoudis
Atypical Femoral Fractures (AFF) represent fractures located between the lesser trochanter and the supracondylar flare of a femur. An increasing pool of evidence supports their association with the prolonged use of bisphosphonates, even though a direct correlation is yet to be proved. The purpose of this review is to encapsulate the current evidence associating bisphosphonate use and the development of AFFs, the clinical features related to their presentation, as well as to report the armamentarium of strategies available in the prevention and treatment of AFFs...
December 16, 2017: Injury
Suneel B Bhat, Asif M Ilyas
Background: Osteoporosis is a common condition among the elderly population, and is associated with an increased risk of fracture. One of the most common fragility fractures involve the distal radius, and are associated with risk of subsequent fragility fracture. Early treatment with bisphosphonates has been suggested to decrease the population hip fracture burden. However, there have been no prior economic evaluations of the routine treatment of distal radius fracture patients with bisphosphonates, or the implications on hip fracture rate reduction...
November 2017: Archives of Bone and Joint Surgery
Sang-Joon Kwak, Yoon-Je Cho, Gwang-Young Jung, Joo-Hyun Lee, Young-Soo Chun, Kee-Hyung Rhyu
Atypical insufficiency fracture of the femur following prolonged bisphosphonate use is well described. Regardless of the cause, insufficiency fracture of the acetabulum is extremely rare, and no reports have described insufficiency fractures of the acetabulum that are associated with prolonged bisphosphonate use. This report demonstrates the possibility of insufficiency fracture at the acetabulum following long-term alendronate use and the necessity of particular care in managing insufficiency fractures in "frozen" bone...
December 2017: Hip & Pelvis
E Michael Lewiecki, John P Bilezikian, John J Carey, Richard M Dell, Catherine M Gordon, Steven T Harris, Michael R McClung, Paul D Miller, Michael Rosenblatt
The 18th Annual Santa Fe Bone Symposium was held on August 4-5, 2017, in Santa Fe, New Mexico, USA. The symposium convenes health-care providers and clinical researchers to present and discuss clinical applications of recent advances in research of skeletal diseases. The program includes lectures, oral presentations by endocrinology fellows, case-based panel discussions, and breakout sessions on topics of interest, with emphasis on participation and interaction of all participants. Topics included the evaluation and treatment of adult survivors with pediatric bone diseases, risk assessment and management of atypical femur fractures, nonpharmacologic strategies in the care of osteoporosis, and skeletal effects of parathyroid hormone with opportunities for therapeutic intervention...
January 2018: Journal of Clinical Densitometry
Suma Uday, Czar Louie Gaston, Luke Rogers, Michael Parry, Johnathan Joffe, John Pearson, David Sutton, Robert Grimer, Wolfgang Högler
Context: Denosumab, an inhibitor of receptor activator of nuclear factor κ-B ligand, is an approved treatment of giant cell tumor of bone (GCTB) in adults and "skeletally mature" adolescents. Safety concerns include oversuppression of bone remodelling, with risk of osteonecrosis of the jaw (ONJ) and atypical femur fractures during treatment in adults and rebound hypercalcemia after treatment cessation in children. To date, ONJ has never been reported in children or adolescents...
February 1, 2018: Journal of Clinical Endocrinology and Metabolism
Jacques P Brown
Antiresorptive drugs, such as amino-bisphosphonates and denosumab (Dmab), have dominated osteoporosis therapies for over 20 years. Since osteoporosis is a chronic disease, antifracture therapy could continue for the rest of a patient's life. Phase III clinical trials for antiresorptive drugs assessed relatively small patient populations for short durations and excluded up to 80% of patients who might seek osteoporosis therapy in clinical practice. Postmarketing reports based upon millions of patient-years and long-term (>5 years) clinical administration have associated some previously unknown, rare adverse events with antiresorptive use including osteonecrosis of the jaw (ONJ) and atypical femur fractures (AFFs)...
January 1, 2017: Toxicologic Pathology
Kyung-Jae Lee, Byung-Woo Min, Kwang-Soon Song, Ki-Cheor Bae, Chul-Hyun Cho, Si-Wook Lee
BACKGROUND: Although atypical femoral fracture (AFF) occurs more frequently in patients taking bisphosphonates and longer treatment is associated with higher risk, the causal relationship between AFF and bisphosphonates has not been established. Most patients with AFF have osteoporosis that is being treated with bisphosphonates, but we are not aware of any reports regarding the areal bone mineral density (aBMD) and discordance between the T-scores of the femur and spine in such patients...
October 4, 2017: Journal of Bone and Joint Surgery. American Volume
Mohammad Kharazmi, Karl Michaëlsson, Pär Hallberg, Jörg Schilcher
Little evidence is available on how to treat incomplete atypical fractures of the femur. When surgery is chosen, intramedullary nailing is the most common invasive technique. However, this approach is adopted from the treatment of other types of ordinary femoral fracture and does not aim to prevent the impending complete fracture by interrupting the mechanism underlying the pathology. We suggest a different surgical approach that intends to counteract the underlying biomechanical conditions leading to a complete atypical fracture and thus could be better suited in selected cases...
February 2018: European Journal of Orthopaedic Surgery & Traumatology: Orthopédie Traumatologie
Andrew J Lovy, Diana Patterson, Laura Skeeles, Richard Ghillani, David Joseph, Yangguan Wu, Rohit Hasija
Atypical femur fractures as a result of long term bisphosphonate use are characterized by several unique radiographic features. We describe an atypical femur fracture treated by cephalomedullary nail with a previously undescribed segmental fracture pattern. Other than 1.5 years of bisphosphonate use the patient did not have any other risk factors known to cause atypical femur fractures. Judicious bisphosphonate use as well as increased awareness of the associated complications may help reduce the rate of bisphosphonate associated atypical femur fractures...
August 2017: Journal of Clinical Orthopaedics and Trauma
(no author information available yet)
No abstract text is available yet for this article.
September 2017: Journal of Orthopaedic Trauma
Daisuke Tateiwa, Hidetatsu Outani, Saya Iwasa, Yoshinori Imura, Takaaki Tanaka, Kazuya Oshima, Norifumi Naka, Nobuhito Araki
Atypical femoral fractures (AFFs) are recently observed as a complication of long-term bone-modifying agent (BMA; bisphosphonate or denosumab) therapy for bone metastases. We describe the cases of two women diagnosed with breast cancer who developed incomplete AFF associated with BMAs prescribed for bone metastases. Radiographs of their femurs revealed thickening of the lateral subtrochanteric cortex, and tomosynthesis revealed a visible fracture line in the thickened cortex. They were initially treated with conservative management; however, the incomplete fracture resulted in a complete fracture...
September 2017: Journal of Orthopaedic Surgery
Seung Hyun Lee, Young Han Lee, Jin-Suck Suh
OBJECTIVE: The objective of our study was to compare subtrochanteric femur bone mineral density (BMD) and bone quality of long-term bisphosphonate (BP) users who sustained an atypical femoral fracture (AFF) with BP users who did not sustain a femoral fracture and BP-naïve patients with no history of femoral fracture using quantitative CT (QCT). MATERIALS AND METHODS: Fourteen female BP users with an AFF (mean age, 72.6 years; mean duration of BP use, 6.2 years; mean body mass index, 21...
October 2017: AJR. American Journal of Roentgenology
Ji Wan Kim, Hyunuk Kim, Chang-Wug Oh, Joon-Woo Kim, Oog-Jin Shon, Young-Soo Byun, Jung Jae Kim, Hyoung Keun Oh, Hiroaki Minehara, Kyu-Tae Hwang, Ki Chul Park
INTRODUCTION: The purpose of the study was to determine the surgical outcomes of intramedullary nailing in diaphyseal atypical femoral fractures (AFFs) and to evaluate the clinical outcomes of nail entry modification technique. MATERIALS AND METHODS: We retrospectively reviewed diaphyseal AFFs treated with IMN at nine institutions. In total, 82 patients were included. Surgical outcomes such as complication, union time, and femoral bowing were evaluated. We modified the nail entry of the straight nail from piriformis fossa to the tip of the greater trochanter in the bowed femur and compared the surgical outcomes between the original group and the modification group...
August 2, 2017: Archives of Orthopaedic and Trauma Surgery
P S Schneider, M Wall, J P Brown, A M Cheung, E J Harvey, S N Morin
The results of a self-administered online survey demonstrate that orthopedic surgeons' management practices for AFF are variable. These data will inform the development of clinical practice guidelines. INTRODUCTION: We aimed to determine current AFF treatment practices of orthopedic surgeons to inform clinical practice guideline development. METHODS: A self-administered online survey was developed and sequentially posted on the Orthopaedic Trauma Association (OTA) website from July to August 2015 and the Canadian Orthopaedic Association (COA) website from December 2015 to January 2016...
November 2017: Osteoporosis International
J H Koh, J P Myong, J Yoo, Y-W Lim, J Lee, S-K Kwok, S-H Park, J H Ju
The risk factors for atypical femur fracture in patients exposed to bisphosphonates for at least 1 year were examined. Prolonged and continuous use of bisphosphonates, long-term use of glucocorticoids, and a higher body mass index were associated with increased risk of atypical femur fracture. INTRODUCTION: The purpose of the present study is to determine whether rheumatoid arthritis (RA) and other clinical factors are associated with an increased risk of bisphosphonate (BP)-related atypical femur fracture (AFF)...
November 2017: Osteoporosis International
Erin S LeBlanc, A Gabriela Rosales, Dennis M Black, Harry K Genant, Richard M Dell, Darin M Friess, David L Boardman, Douglas C Bauer, Anne de Papp, Arthur C Santora, Eric S Orwoll
Identification of atypical femoral fractures (AFFs) can be challenging. To assist in the radiological assessment, an American Society for Bone and Mineral Research (ASBMR) Task Force developed a case definition for AFFs in 2010, revising it in 2013. How the revised definition performs in a community setting compared with the 2010 definition is unknown. We applied the 2013 criteria to 372 femoral fractures that occurred between January 1, 1996, and June 30, 2009, employing two independent expert physician reviewers...
November 2017: Journal of Bone and Mineral Research: the Official Journal of the American Society for Bone and Mineral Research
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