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Atypical femur fractures

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https://www.readbyqxmd.com/read/29339529/management-of-endocrine-disease-atypical-femoral-fractures-risks-and-benefits-of-long-term-treatment-of-osteoporosis-with-anti-resorptive-therapy
#1
Robert Adler
Modern osteoporosis treatment began in the mid-1990's 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...
January 16, 2018: European Journal of Endocrinology
https://www.readbyqxmd.com/read/29338853/atypical-fractures-an-issue-of-concern-or-a-myth
#2
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
https://www.readbyqxmd.com/read/29299492/economic-analysis-of-bisphosphonate-use-after-distal-radius-fracture-for-prevention-of-hip-fracture
#3
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
https://www.readbyqxmd.com/read/29250504/acetabular-insufficiency-fracture-following-prolonged-alendronate-use-and-the-failure-of-total-hip-arthroplasty-in-frozen-bone-two-cases-report
#4
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
https://www.readbyqxmd.com/read/29229501/proceedings-of-the-2017-santa-fe-bone-symposium-insights-and-emerging-concepts-in-the-management-of-osteoporosis
#5
REVIEW
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...
November 20, 2017: Journal of Clinical Densitometry
https://www.readbyqxmd.com/read/29211870/osteonecrosis-of-the-jaw-and-rebound-hypercalcaemia-in-young-people-treated-with-denosumab-for-giant-cell-tumour-of-bone
#6
Suma Uday, 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 kappa-B ligand, is an approved treatment for giant cell tumour 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 hypercalcaemia after treatment cessation in children. To date, ONJ has never been reported in children or adolescents...
December 1, 2017: Journal of Clinical Endocrinology and Metabolism
https://www.readbyqxmd.com/read/29065818/antiresorptives-safety-concerns-clinical-perspective
#7
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
https://www.readbyqxmd.com/read/28976433/t-score-discordance-of-bone-mineral-density-in-patients-with-atypical-femoral-fracture
#8
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
https://www.readbyqxmd.com/read/28924690/lateral-fixation-an-alternative-surgical-approach-in-the-prevention-of-complete-atypical-femoral-fractures
#9
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...
September 18, 2017: European Journal of Orthopaedic Surgery & Traumatology: Orthopédie Traumatologie
https://www.readbyqxmd.com/read/28878545/atraumatic-segmental-atypical-femur-fracture-secondary-to-bisphosphonate-use-a-case-report
#10
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
https://www.readbyqxmd.com/read/28876272/intramedullary-nail-fixation-of-atypical-femur-fractures-with-bone-marrow-aspirate-concentrate-leads-to-faster-union-a-case-control-study-erratum
#11
(no author information available yet)
No abstract text is available yet for this article.
September 2017: Journal of Orthopaedic Trauma
https://www.readbyqxmd.com/read/28844196/atypical-femoral-fracture-associated-with-bone-modifying-agent-for-bone-metastasis-of-breast-cancer-a-report-of-two-cases
#12
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
https://www.readbyqxmd.com/read/28796551/lateral-cortical-thickening-and-bone-heterogeneity-of-the-subtrochanteric-femur-measured-with-quantitative-ct-as-indicators-for-early-detection-of-atypical-femoral-fractures-in-long-term-bisphosphonate-users
#13
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
https://www.readbyqxmd.com/read/28770350/surgical-outcomes-of-intramedullary-nailing-for-diaphyseal-atypical-femur-fractures-is-it-safe-to-modify-a-nail-entry-in-bowed-femur
#14
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
https://www.readbyqxmd.com/read/28770273/atypical-femur-fractures-a-survey-of-current-practices-in-orthopedic-surgery
#15
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
https://www.readbyqxmd.com/read/28748389/predisposing-factors-associated-with-atypical-femur-fracture-among-postmenopausal-korean-women-receiving-bisphosphonate-therapy-8%C3%A2-years-experience-in-a-single-center
#16
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
https://www.readbyqxmd.com/read/28731209/evaluating-atypical-features-of-femur-fractures-how-change-in-radiological-criteria-influenced-incidence-and-demography-of-atypical-femur-fractures-in-a-community-setting
#17
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
https://www.readbyqxmd.com/read/28632656/intramedullary-nail-fixation-of-atypical-femur-fractures-with-bone-marrow-aspirate-concentrate-leads-to-faster-union-a-case-control-study
#18
Andrew J Lovy, Jun S Kim, John Di Capua, Sulaiman Somani, Stephanie Shim, Aakash Keswani, Rohit Hasija, Yangguan Wu, David Joseph, Richard Ghillani
OBJECTIVES: To evaluate bone marrow aspirate concentrate (BMAC) use in the treatment of AFF. DESIGN: Retrospective case control. SETTING: Level 1 trauma center. PATIENTS: Complete AFF, defined according to American Society of Bone and Mineral Research (ASBMR) criteria, from September 2009 to April 2015 with minimum 1-year follow-up. INTERVENTION: Operative treatment with antegrade intramedullary nails...
July 2017: Journal of Orthopaedic Trauma
https://www.readbyqxmd.com/read/28612307/atypical-subtrochanteric-fractures-in-korean-hip-fracture-study
#19
Y-K Lee, T-Y Kim, Y-C Ha, S-H Song, J W Kim, H C Shon, J S Chang, K-H Koo
In Korean, atypical subtrochanteric fractures (ASF) were rare. Higher BMI and use of bisphosphonate were significant risk factors of ASF. INTRODUCTION: Recently, ASF have been reported to increase among patients on bisphosphonate. However, the incidence of ASF and the association between ASF and bisphosphonate use have not been well defined in Asian population. Our purposes are (1) to estimate the proportion of ASF among Korean patients with proximal femur fracture and (2) to determine the associated risk factors of ASF in the Korean patients...
June 14, 2017: Osteoporosis International
https://www.readbyqxmd.com/read/28535898/treatment-of-postmenopausal-osteoporosis-a-literature-based-algorithm-for-use-in-the-public-health-care-system
#20
Ellen Luz Pereira Caires, Mailze Campos Bezerra, Ana Flávia Torquato de Araújo Junqueira, Sheila Márcia de Araújo Fontenele, Silvana Cristina de Albuquerque Andrade, Catarina Brasil d'Alva
Bisphosphonates are considered first-line agents in the treatment of postmenopausal osteoporosis based on extensive experience of use, safety, and proven efficacy in reducing vertebral, non-vertebral and femur fractures. However, post-marketing reports based on the treatment of millions of patients/year over lengthy periods of time have revealed the occurrence of initially unexpected adverse effects, such as osteonecrosis of the jaw and atypical femoral fracture, leading to the restriction of treatment duration with bisphosphonates by global regulatory agencies...
May 2017: Revista Brasileira de Reumatologia
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