title: Surgical treatment improves clinical and functional outcomes for patients who sustain incomplete bisphosphonate-related femur fractures.
abstract: OBJECTIVE
  To describe the outcomes for patients treated at a single institution, who sustained incomplete bisphosphonate-induced femoral fractures.
  
  
  METHODS
  Retrospective review.
  
  
  METHODS
  University-based academic medical center.
  
  
  METHODS
  Thirty-one patients with 43 incomplete fractures met the inclusion criteria.
  
  
  METHODS
  Nonoperative management or surgical intervention for fractures with refractory symptoms or progression of fracture lucency on radiographs.
  
  
  METHODS
  Radiographic assessments and the Short Musculoskeletal Functional Assessment to gauge functional status.
  
  
  RESULTS
  The cohort was all women with an average age of 69.2 (range: 46-92) years and had been treated with bisphosphonate therapy for an average of 9.1 (range: 5-20) years. The average healing time for all incomplete fractures was 9.4 (range: 1.5-36) months. Forty-nine percent of the fractures (21 of 43 fractures) were ultimately treated with surgery for impending complete fracture or failure of nonsurgical management. Of the incomplete fractures treated with surgery, 81% became pain free and 100% were radiographically healed at a mean of 7.1 (range: 1.5-12) months. In contrast, of the nonoperatively treated incomplete fractures, only 64% were pain free at latest follow-up, with only 18% of fractures demonstrating radiographic evidence of healing at an average of 11 (range: 6-24) months. Standardized dysfunction index from the Short Musculoskeletal Functional Assessment was better (19.7) in the surgical group than in the nonsurgical group (19.7 vs. 25.7, P = 0.0017).
  
  
  CONCLUSIONS
  A higher percentage of patients treated surgically became asymptomatic and demonstrated radiographic evidence of healing earlier than those treated nonsurgically. Surgical intervention is effective for relief of symptoms when treating incomplete bisphosphonate-related femur fractures, and patients should be counseled to the potential benefits of prophylactic surgery.
  
  
  METHODS
  Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
authors.affiliation: Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, NY 10003, USA. kenneth.egol@nyumc.org
authors.forename: Kenneth A
authors.initials: KA
authors.lastname: Egol
authors.forename: Ji H
authors.initials: JH
authors.lastname: Park
authors.forename: Colin
authors.initials: C
authors.lastname: Prensky
authors.forename: Zehava S
authors.initials: ZS
authors.lastname: Rosenberg
authors.forename: Valerie
authors.initials: V
authors.lastname: Peck
authors.forename: Nirmal C
authors.initials: NC
authors.lastname: Tejwani
mesh_terms: D000368:Aged; D050071:Bone Density Conservation Agents / Q000627:therapeutic use; D015984:Causality; D015897:Comorbidity; D004164:Diphosphonates / Q000627:therapeutic use*; D064420:Drug-Related Side Effects and Adverse Reactions / Q000453:epidemiology*; D005260:Female; D005264:Femoral Fractures / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery*; D005593:Fracture Fixation, Internal / Q000706:statistics & numerical data*; D017102:Fracture Healing; D006801:Humans; D008875:Middle Aged; D009518:New York / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology*; D015995:Prevalence; D020127:Recovery of Function; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D050071:Bone Density Conservation Agents; D004164:Diphosphonates