Preventive bilateral femoral nailing in atypical femoral fracture non responder to anabolic therapy: case report and mini-review

Preventive bilateral femoral nailing in atypical femoral fracture non responder to anabolic therapy: case report and mini-review

Authors

  • Elisabetta Neri Azienda Ospedaliera Universitaria Pisana
  • Livia Gabriele Azienda Ospedaliera Universitaria Pisana
  • Vanna Bottai Azienda Ospedaliera Universitaria Pisana
  • Lorenzo Andreani Azienda Ospedaliera Universitaria Pisana
  • Enrico Bonicoli Azienda Ospedaliera Universitaria Pisana
  • Michelangelo Scaglione Azienda Ospedaliera Universitaria Pisana

Keywords:

AFF, preventive rodding, nail, bisphosphonates, teriparatide, osteoporosis, atypical femur fracture

Abstract

Currently bisphosphonates are the main antiresorptive medications used in osteoporosis. However, a prolonged use of these drugs is associated to an increased risk of atypical femoral fractures, especially in patients suffering from others predisposing clinical conditions.

This report describes a case of a woman presenting bilateral impending femoral fracture initially treated with bisphosphonates suspension and intramedullary nailing of right femur. Despite anabolic therapy, the patient presented progression of incomplete contralateral femoral fracture which required a second surgical treatment.

References

1. Hernlund E, Svedbom A, Ivergård et al. Osteoporosis in the European Union: medical management, epidemiology and economic burden. A report prepared in collaboration with the International Osteoporosis Foundation (IOF) and the European Federation of Pharmaceutical Industry Associations (EFPIA). Arch Osteoporos (2013) 8:136
2. Caggiari G, Leali PT, Mosele GR, Puddu L, Badessi F, Doria C. Safety and effectiveness of teriparatide vs alendronate in postmenopausal osteoporosis: A prospective non randomized clinical study. Clinical Cases in Mineral and Bone Metabolism (2016) 13 (2), pp. 200-203.
3. 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 Mar;99-B(3):295-302.
4. 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) 90:1294– 1301.
5. 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. J Bone Miner Res 2010;25:2267–2294.
6. 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 Apr 1;40(2):333-368.
7. 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. J Bone Miner Res. 2016 Oct;31(10):1910.
8. Giannini S1, Chiarello E, Tedesco G, et al. Atypical femoral fractures. Clin Cases Miner Bone Metab. 2013 Jan;10(1):30-3.
9. Goh SK, Yang KY, Koh JSB et al. Subtrochanteric insufficiency fractures in patients on alendronate therapy: a caution. J Bone Joint Surg Br (2007) (3):349–353.
10. Shane E, Burr D, Abrahamsen B, Adler RA, Brown TD, Cheung AM, et al. Atypical subtrochanteric and diaphyseal femoral frac- tures: second report of a task force of the American Society for Bone and Mineral Research. J Bone Miner Res. 2014;29(1):1–23.
11. Png MA, Koh JS, Goh SK, Fook-Chong S, Howe TS. Bisphosphonate-related femoral periosteal stress reactions: scoring system based on radiographic and MRI findings. AJR Am J Roentgenol. 2012;198(4):869-877. doi:10.2214/AJR.11.6794
12. Abrahamsen B, Eiken P, Eastell R. Cumulative alendronate dose and the long- term absolute risk of subtrochanteric and diaphyseal femur fractures: a register- based national cohort analysis. J Clin Endocrinol Metab 2010;95:5258–5265.
13. Kim SY, Schneeweiss S, Katz JN, et al. Oral bisphosphonates and risk of subtrochanteric or diaphyseal femur fractures in a population-based cohort. J Bone Miner Res 2011 May;26(5):993-1001.
14. Dell R, Greene D. A proposal for an atypical femur fracture treatment and prevention clinical practice guideline. Osteoporos Int. 2018 Jun;29(6):1277-1283.
15. Sayed-Noor AS, Sjoden GO. Two femoral insufficiency fractures after long-term alendronate therapy. Clinical Orthop Relat Res 2009;467:1921-1926.
16. Lee JYY, Soh T, Howe TS, Koh JSB, Kwek EBK, Chua DTC. Bisphosphonate-associated peri implant fractures: a new clinical entity?. Acta Orthopaedica. 2015. 86(5):622-626.
17. Robinson Jde D, Leighton RK, Trask K, Bogdan Y, Tornetta P 3rd. Periprosthetic Atypical Femoral Fractures in Patients on Long-term Bisphosphonates: A Multicenter Retrospective Review. J Orthop Trauma. 2016;30(4):170-176.
18. Giannotti S, Bottai V, Dell’Osso G, et al. Pseudoarthrosis in atypical femoral fracture: case report. Osteoporos Int 2013;24:2893–2895.
19. Prasarn ML, Ahn J, Helfet DL, Lane JM et al. Bisphosphonate-associated femur fractures have high complication rates with operative fixation. Clin Orthop Relat Res. 2012 Aug;470(8):2295-301.
20. Im G, Lee S. Effect of Teriparatide on Healing of Atypical Femoral Fractures: A Systemic Review. J Bone Metab. 2015 Nov;22(4):183-9.
21. Marshall RA, Mandell JC, Weaver MJ, Ferrone M, Sodickson A, Khurana B. Imaging Features and Management of Stress, Atypical, and Pathologic Fractures. Radiographics. 2018;38(7):2173-2192.
22. LeBlanc ES, Rosales AG, Genant HK, et al. Radiological criteria for atypical features of femur fractures: what we can learn when applied in a clinical study setting. Osteoporos Int. 2019;30(6):1287-1295.

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Published

20-01-2022

How to Cite

1.
Neri E, Gabriele L, Bottai V, Andreani L, Bonicoli E, Scaglione M. Preventive bilateral femoral nailing in atypical femoral fracture non responder to anabolic therapy: case report and mini-review. Acta Biomed. 2022;92(S1):e2021130. doi:10.23750/abm.v92iS1.10452