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Atypical femoral fracture due to chronic use of bisphosphonates: case report.

Temponi EF, de Carvalho Junior LH, Costa LP - Rev Bras Ortop (2015)

Bottom Line: The causal relationship between chronic use of bisphosphonates and occurrences of atypical femoral fractures has not yet been established.Atypical fractures are still rare events and the benefit from using bisphosphonates remains greater for prevention and treatment of osteoporosis.Abstract available from the publisher.

View Article: PubMed Central - PubMed

Affiliation: Hospital Madre Teresa, Belo Horizonte, MG, Brazil.

ABSTRACT
The causal relationship between chronic use of bisphosphonates and occurrences of atypical femoral fractures has not yet been established. Nonetheless, it is known that their chronic use is more related to fractures with a pattern differing from that of classical osteoporotic fractures. Atypical fractures are still rare events and the benefit from using bisphosphonates remains greater for prevention and treatment of osteoporosis. There are few studies guiding the diagnosis and management of these fractures, thus making it difficult to achieve better results. In this report, we present the case of an elderly patient with an atypical femoral fracture that was managed in accordance with guidance from the American Society for Bone and Mineral Research.

No MeSH data available.


Related in: MedlinePlus

Preoperative radiological evaluation. (a, b) Radiographic images showing area of sclerosis in the middle third and synthesis material from previous femoral fracture and (c, d) magnetic resonance imaging slices showing area of incomplete fracture in the posterolateral cortical bone, with permeating edema.
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fig0005: Preoperative radiological evaluation. (a, b) Radiographic images showing area of sclerosis in the middle third and synthesis material from previous femoral fracture and (c, d) magnetic resonance imaging slices showing area of incomplete fracture in the posterolateral cortical bone, with permeating edema.

Mentions: She sought the orthopedics and traumatology outpatient clinic of our service in February 2014, in order to have her complaint investigated. She had a history of a left-side proximal femoral fracture 6 years previously, which had been treated at our institution, without any complaint. She also reported that since then, she had been using calcium replacement and had kept on using bisphosphonates over the same period. She did not present any abnormality in the clinical examination, except for discomfort in her right lower limb, at thigh level when walking. Serial radiographs demonstrated normality and good evolution of the left-side fracture that had previously been treated, but with arching of the femoral cortical bone and sclerosis of the lateral wall in its middle third. In the light of these findings, magnetic resonance imaging of the thigh was requested. This showed the presence of incomplete fracturing of the posterolateral/lateral cortical bone with thickening of the adjacent cortical bone and bone edema, in association with slight unilamellar periosteal thickening. Investigation of laboratory parameters did not show any associated metabolic abnormality (Fig. 1).


Atypical femoral fracture due to chronic use of bisphosphonates: case report.

Temponi EF, de Carvalho Junior LH, Costa LP - Rev Bras Ortop (2015)

Preoperative radiological evaluation. (a, b) Radiographic images showing area of sclerosis in the middle third and synthesis material from previous femoral fracture and (c, d) magnetic resonance imaging slices showing area of incomplete fracture in the posterolateral cortical bone, with permeating edema.
© Copyright Policy - CC BY-NC-ND
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4563046&req=5

fig0005: Preoperative radiological evaluation. (a, b) Radiographic images showing area of sclerosis in the middle third and synthesis material from previous femoral fracture and (c, d) magnetic resonance imaging slices showing area of incomplete fracture in the posterolateral cortical bone, with permeating edema.
Mentions: She sought the orthopedics and traumatology outpatient clinic of our service in February 2014, in order to have her complaint investigated. She had a history of a left-side proximal femoral fracture 6 years previously, which had been treated at our institution, without any complaint. She also reported that since then, she had been using calcium replacement and had kept on using bisphosphonates over the same period. She did not present any abnormality in the clinical examination, except for discomfort in her right lower limb, at thigh level when walking. Serial radiographs demonstrated normality and good evolution of the left-side fracture that had previously been treated, but with arching of the femoral cortical bone and sclerosis of the lateral wall in its middle third. In the light of these findings, magnetic resonance imaging of the thigh was requested. This showed the presence of incomplete fracturing of the posterolateral/lateral cortical bone with thickening of the adjacent cortical bone and bone edema, in association with slight unilamellar periosteal thickening. Investigation of laboratory parameters did not show any associated metabolic abnormality (Fig. 1).

Bottom Line: The causal relationship between chronic use of bisphosphonates and occurrences of atypical femoral fractures has not yet been established.Atypical fractures are still rare events and the benefit from using bisphosphonates remains greater for prevention and treatment of osteoporosis.Abstract available from the publisher.

View Article: PubMed Central - PubMed

Affiliation: Hospital Madre Teresa, Belo Horizonte, MG, Brazil.

ABSTRACT
The causal relationship between chronic use of bisphosphonates and occurrences of atypical femoral fractures has not yet been established. Nonetheless, it is known that their chronic use is more related to fractures with a pattern differing from that of classical osteoporotic fractures. Atypical fractures are still rare events and the benefit from using bisphosphonates remains greater for prevention and treatment of osteoporosis. There are few studies guiding the diagnosis and management of these fractures, thus making it difficult to achieve better results. In this report, we present the case of an elderly patient with an atypical femoral fracture that was managed in accordance with guidance from the American Society for Bone and Mineral Research.

No MeSH data available.


Related in: MedlinePlus