CONTEXT: An online voluntary association of individuals who had incurred one or more atypical femur fractures (AFFs) while taking bisphosphonates for prevention or treatment of osteoporosis provided an opportunity to collect long-term histories. SETTING: Individuals from a nationwide general community completed an anonymous survey documenting their history. PARTICIPANTS: Within a larger cadre, cases were selected where the documentation, including fracture radiographs, verified the diagnosis based on published standards. Eighty-one of this group responded to the anonymous survey. INTERVENTIONS: We describe passively collected observational data only. OUTCOME MEASURES: The incidence of a large number of potential variations was determined. RESULTS: The mean duration of bisphosphonate treatment was 9.5 yr. Prevention was the initial indication in 68% of the subjects; 94% started on alendronate, 77% reported prodromal pain, only 16% of these were diagnosed with incident stress fractures, and 39.5% experienced a contralateral AFF from less than 1 month to 49 months after the first. Of 71 subjects with a completed first AFF, 38% reported delayed healing, 11% had a complete contralateral AFF, and 22% underwent prophylactic rodding for a contralateral stress AFF. Forty-four percent of subjects with complete AFFs were continued on a bisphosphonate after the fracture. Thirty-five percent incurred a metatarsal fracture. CONCLUSIONS: AFF patients experienced delayed healing, prodromal pain, and persisting risk of a contralateral and/or other fracture. Femur pain evaluation in patients on long-term bisphosphonates may facilitate early diagnosis of stress AFFs, permitting intervention, thus reducing completed and/or contralateral or other fracture risk. The details of these histories will assist in counseling regarding prognosis after an initial AFF.
CONTEXT: An online voluntary association of individuals who had incurred one or more atypical femur fractures (AFFs) while taking bisphosphonates for prevention or treatment of osteoporosis provided an opportunity to collect long-term histories. SETTING: Individuals from a nationwide general community completed an anonymous survey documenting their history. PARTICIPANTS: Within a larger cadre, cases were selected where the documentation, including fracture radiographs, verified the diagnosis based on published standards. Eighty-one of this group responded to the anonymous survey. INTERVENTIONS: We describe passively collected observational data only. OUTCOME MEASURES: The incidence of a large number of potential variations was determined. RESULTS: The mean duration of bisphosphonate treatment was 9.5 yr. Prevention was the initial indication in 68% of the subjects; 94% started on alendronate, 77% reported prodromal pain, only 16% of these were diagnosed with incident stress fractures, and 39.5% experienced a contralateral AFF from less than 1 month to 49 months after the first. Of 71 subjects with a completed first AFF, 38% reported delayed healing, 11% had a complete contralateral AFF, and 22% underwent prophylactic rodding for a contralateral stress AFF. Forty-four percent of subjects with complete AFFs were continued on a bisphosphonate after the fracture. Thirty-five percent incurred a metatarsal fracture. CONCLUSIONS: AFF patients experienced delayed healing, prodromal pain, and persisting risk of a contralateral and/or other fracture. Femur pain evaluation in patients on long-term bisphosphonates may facilitate early diagnosis of stress AFFs, permitting intervention, thus reducing completed and/or contralateral or other fracture risk. The details of these histories will assist in counseling regarding prognosis after an initial AFF.
Authors: Robert A Adler; Ghada El-Hajj Fuleihan; Douglas C Bauer; Pauline M Camacho; Bart L Clarke; Gregory A Clines; Juliet E Compston; Matthew T Drake; Beatrice J Edwards; Murray J Favus; Susan L Greenspan; Ross McKinney; Robert J Pignolo; Deborah E Sellmeyer Journal: J Bone Miner Res Date: 2016-01 Impact factor: 6.741
Authors: Malachi J McKenna; Fergus E McKiernan; Bernie McGowan; Carmel Silke; Kathleen Bennett; Susan van der Kamp; Paul Ward; Conor Hurson; Eric Heffernan Journal: J Endocr Soc Date: 2017-02-13
Authors: Michalis Panteli; James S H Vun; Robert M West; Anthony J Howard; Ippokratis Pountos; Peter V Giannoudis Journal: J Clin Med Date: 2021-11-29 Impact factor: 4.241