Treatment and Prognosis of Femoral Insufficiency Fracture Associated with Prolonged Bisphosphonate Use

Ki Chan An; Dae Hyun Park; Guemin Gong; Ju-Young Kim; Sang-Bum Kim; Seung-Yeob Sakong

doi:10.12671/jkfs.2014.27.1.10

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An, Park, Gong, Kim, Kim, and Sakong: Treatment and Prognosis of Femoral Insufficiency Fracture Associated with Prolonged Bisphosphonate Use

Original Article

Journal of the Korean Fracture Society 2014; 27(1): 10-16.

Published online: 17 January 2014

DOI: https://doi.org/10.12671/jkfs.2014.27.1.10

Treatment and Prognosis of Femoral Insufficiency Fracture Associated with Prolonged Bisphosphonate Use

Ki Chan An, M.D., Dae Hyun Park, M.D., Guemin Gong, M.D., Ju-Young Kim, M.D., Sang-Bum Kim, M.D., Seung-Yeob Sakong, M.D.

Department of Orthopedic Surgery, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea.

Address reprint requests to: Dae Hyun Park, M.D. Department of Orthopedic Surgery, Busan Paik Hospital, Inje University College of Medicine, 75 Bokji-ro, Busanjin-gu, Busan 614-735, Korea. Tel: 82-51-890-6257, Fax: 82-51-892-6619, ronin211@naver.com

Received 10 April 2013 Revised 2 July 2013 Accepted 15 September 2013

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

This study was conducted to investigate and identify an appropriate fracture treatment method by analyzing patients in whom a femoral incompetence fracture occurred after receiving a long-term bisphosphonate administration.

Materials and Methods

The subjects of this study were 13 cases out of ten patients among those who had a history of receiving bisphosphonate for more than five years and had a fracture or an imminent fracture with a characteristic radiological finding in the femoral subtrochanteric region and the interfemoral region. The period of the drug administration, bone density, the existence of a prodromal symptom, and bilateral fracture were investigated.

Results

In seven out of the 13 cases, the patients complained of painat the femoral and pelvic parts as a prodrome (53.8%), and three of them showed a bilateral fracture (30%). An imminent fracture with a prodrome was observed in six cases (46.2%); for three of these cases, a prophylactic fixture pexis was performed by inserting a metal nail into the medullary cavity, and in two out of these three, a complete fracture was found within 11 months on average (3 to 19 months). In the three prophylactic fixture pexis performed cases, no postoperative complications were found, and a radiological finding of concrescence was seen within one year after the operation. Among the nine operation performed cases after the fracture, non-union was found in two.

Conclusion

In the patients who have received bisphosphonate for a long periodof time, a prodome may be a useful indicator of a fracture in the femoral subtrochanteric region and the interfemoral region; therefore, a careful observation is necessary. A prophylactic internal fixation is recommended for patients with imminent fracture with a prodome since they have a high risk of a complete fracture is high in them.

Keywords: Bisphophonate, Femoral incompetence fracture, Femoral imminent fracture

Figures and Tables

Fig. 1

A 79-year-old woman was diagnosed as subtrochanteric fracture of the right femur after slipping (A). Internal fixation using intramedullary nail (B). Nine months after the surgery, non-union was confirmed (C). Bone grafting (D) union was observed 1 year after the surgery (E).

Fig. 2

Specific radiologic finding.

Fig. 3

An 86-year-old woman was diagnosed with left femoral shaft fracture and received internal fixation using intramedullary nail. On arrival, incomplete fracture of femoral shaft and prodromal symptom was confirmed on the other side (A) prophylactic intramedullary nailing was done (B). Bone union was observed 1 year after the surgery (C).

Table 1

Baseline Characteristics of the Patient

Values are presented as median (range). BMD: Bone mineral density.

Table 2

Character of Insufficiency Fracture

Values are presented as number (%) or only number.

Table 3

Comparison of Prophylactic Fixation and Postfracture Fixation

Values are presented as median (range) or percent.

Notes

This research was supported by 2013 scientific reasearch of Inje University.

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