Atypical Subtrochanteric and Diaphyseal Femoral Fractures: Second Report of a Task Force of the American Society for Bone and Mineral Research

@article{Shane2014AtypicalSA,
  title={Atypical Subtrochanteric and Diaphyseal Femoral Fractures: Second Report of a Task Force of the American Society for Bone and Mineral Research},
  author={Elizabeth Shane and David B. Burr and Bo Abrahamsen and Robert A. Adler and Thomas D. Brown and Angela M. Cheung and Felicia Cosman and Jeffrey R. Curtis and Richard M. Dell and David W. Dempster and Peter R. Ebeling and Thomas A Einhorn and Harry K. Genant and Piet P M Geusens and Klaus Klaushofer and Joseph Michael Lane and Fergus Eoin McKiernan and Ross E. McKinney and Alvin Choong Meng Ng and Jeri W. Nieves and Regis J. O’Keefe and Socrates E. Papapoulos and Tet Sen Howe and Marjolein C. H. van der Meulen and Robert S. Weinstein and Michael P. Whyte},
  journal={Journal of Bone and Mineral Research},
  year={2014},
  volume={29}
}
Bisphosphonates (BPs) and denosumab reduce the risk of spine and nonspine fractures. Atypical femur fractures (AFFs) located in the subtrochanteric region and diaphysis of the femur have been reported in patients taking BPs and in patients on denosumab, but they also occur in patients with no exposure to these drugs. In this report, we review studies on the epidemiology, pathogenesis, and medical management of AFFs, published since 2010. This newer evidence suggests that AFFs are stress or… 

Bone Formation Parameters of the Biopsied Ilium Differ between Subtrochanteric and Diaphyseal Atypical Femoral Fractures in Bisphosphonate-Treated Patients.

Bone formation was inhibited more severely in subtrochanteric than in the diaphyseal group due to the higher GC doses used, and bone histomorphometry of the biopsied iliac bone showed SSBT in 3 cases.

Differences in subtrochanteric and diaphyseal atypical femoral fractures in a super-aging prefectural area: YamaCAFe Study

The onset of ST AFFs have greater correlation with the worse bone quality, vice versa, and the onset of DP AFFS correlated with the bone geometry are suggested.

Critical differences between subtrochanteric and diaphyseal atypical femoral fractures: analyses of 51 cases at a single institution in Korean population

Angle of lateral bowing (FNSBA) and spine BMD showed significant differences between subtrochanteric and diaphyseal atypical fracture groups and may play important roles in the AFF locations, according to the results.

The enigma of atypical femoral fractures

Key features of atypical femoral fractures, essential for the diagnosis, are: location in the subtrochanteric region and diaphysis; lack of trauma history and comminution; and a transverse or short oblique configuration.

Subtrochanteric and diaphyseal femoral fractures in hypophosphatasia—not atypical at all

Risk for subtrochanteric and diaphyseal femoral fractures in HPP appears to result from both compromised bone metabolism as well as disease-associated bone deformities, and generous screening for such fractures seems advisable.

Bisphosphonate-associated Atypical Fractures that are not “Atypical Femoral Fractures”

The present authors have been following the development of these non-AFF bisphosphonateassociated fractures since 2005 and have collected a large amount of historical and current information on the subject and find that many useful inferences can be derived from considering it as a systemic rather than localized effect.

Atypical Femoral Fracture in a Patient without Bisphosphonate or Denosumab Exposure-A Case Report

AFFs may occur even in patients who have never been exposed to BPs or denosumab, and the absence of antiresorptive osteoporosis therapy and the lack of radiographic focal periosteal reaction in the lateral femoral cortex can make it difficult to detect and prevent the disorder.

Atypical subtrochanteric and diaphyseal femoral fractures associated with a bisphosphonate therapy

This study presents an analysis of 11 patients with atypical fracture with documented bisphosphonate treatment for a minimum of 3 years and concluded that intramedullary osteosynthesis of atypicals fractures as well as prophylactic osteos synthesis in the case of a possible fracture of the opposite limb is an effective method of treatment.
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References

SHOWING 1-10 OF 239 REFERENCES

Atypical subtrochanteric and diaphyseal femoral fractures: Report of a task force of the american society for bone and mineral Research

  • E. ShaneD. Burr M. Whyte
  • Medicine
    Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research
  • 2010
Given the relative rarity of atypical femoral fractures, the task force recommends that specific diagnostic and procedural codes be created and that an international registry be established to facilitate studies of the clinical and genetic risk factors and optimal surgical and medical management of these fractures.

Incidence of atypical nontraumatic diaphyseal fractures of the femur

  • R. DellA. Adams S. Ott
  • Medicine
    Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research
  • 2012
The incidence of atypical fractures of the femur increases with longer duration of bisphosphonate use, and patients at risk for osteoporotic fractures should not be discouraged from initiating bisph phosphate medicines, because clinical trials have documented that these medicines can substantially reduce the incidence of typical hip fractures.

Bisphosphonates and fractures of the subtrochanteric or diaphyseal femur.

The occurrence of fracture of the subtrochanteric or diaphyseal femur was very rare, even among women who had been treated with bisphosphonates for as long as 10 years, and the study was underpowered for definitive conclusions.

Atypical subtrochanteric femoral shaft fractures: role for mechanics and bone quality

The association of AFFs with no or minimal trauma suggests a fatigue-based mechanism that depends on cortical cross-sectional geometry and tissue material properties, and bisphosphonate treatment may alter cortical tissue properties, as these agents are known to alter bone remodeling.

Atypical femoral diaphyseal and subtrochanteric fractures and their association with bisphosphonates

Although the incidence of bisphosphonate-related atypical fracture accounts for an extremely low percentage of the total number of femoral diaphyseal and subtrochanteric fractures, there is a steady increase from 0% in 2003 to 2004 to 25% in 2007 to 2008.

Low-energy diaphyseal femoral fractures associated with bisphosphonate use and severe curved femur: a case series

Investigation of associations between occurrence of low-energy subtrochanteric and diaphyseal femoral fractures after long-term bisphosphonate treatment, bisph phosphonate use, and curvature of the femur found increased femoral curvature might be a causative factor for low- energies femoral fracture in the elderly.

Are women with thicker cortices in the femoral shaft at higher risk of subtrochanteric/diaphyseal fractures? The study of osteoporotic fractures.

In primarily bisphosphonate-naive women, it was found that thick femoral cortices placed women at higher risk for low-energy S/D femur fractures; in fact, the opposite was true.

Atypical femoral fractures during prolonged use of bisphosphonates: short-term responses to strontium ranelate and teriparatide.

It is shown that both teriparatide and strontium ranelate had a rapid bone anabolic effect on unhealed atypical fractures associated with chronic bisphosphonate use.
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