title: Unusual Femur Stress Fractures in Children With Osteogenesis Imperfecta and Intramedullary Rods on Long-term Intravenous Pamidronate Therapy.
abstract: In this report, we describe 6 children with osteogenesis imperfecta with unusual stress femoral fractures. All children were on long-term cyclic pamidronate treatment. All fractures occurred without trauma or with minimal trauma and were located in the subtrochanteric or the diaphyseal regions of the femur over preexisting intramedullary rods. These fractures have very similar features to the reported minimal trauma atypical femoral fractures in adults on long-term bisphosphonate treatment. These fractures raise concerns about the role of prolonged remodeling suppression and microdamage accumulation and the risk of increased bone fragility.
authors.affiliation: *Orthopaedic Division †Endocrinology Division, Hospital for Sick Children, University of Toronto ‡Osteoporosis Program, University Health Network/University of Toronto, Toronto, ON, Canada.
authors.forename: Abdelsalam
authors.initials: A
authors.lastname: Hegazy
authors.forename: Mohamed
authors.initials: M
authors.lastname: Kenawey
authors.forename: Etienne
authors.initials: E
authors.lastname: Sochett
authors.forename: Lianne
authors.initials: L
authors.lastname: Tile
authors.forename: Angela M
authors.initials: AM
authors.lastname: Cheung
authors.forename: Andrew W
authors.initials: AW
authors.lastname: Howard
mesh_terms: D061605:Administration, Intravenous; D000293:Adolescent; D050071:Bone Density Conservation Agents / Q000008:administration & dosage / Q000009:adverse effects; D002648:Child; D004164:Diphosphonates / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D005264:Femoral Fractures / Q000175:diagnosis / Q000209:etiology / Q000601:surgery; D005269:Femur / Q000000981:diagnostic imaging*; D005594:Fracture Fixation, Intramedullary / Q000295:instrumentation / Q000379:methods; D015775:Fractures, Stress / Q000175:diagnosis / Q000209:etiology / Q000601:surgery; D006801:Humans; D016268:Internal Fixators; D000069451:Long Term Adverse Effects / Q000209:etiology; D008297:Male; D010013:Osteogenesis Imperfecta / Q000150:complications / Q000188:drug therapy; D010043:Outcome and Process Assessment, Health Care; D000077268:Pamidronate
chemical_list: D050071:Bone Density Conservation Agents; D004164:Diphosphonates; D000077268:Pamidronate