title: Long-term radiographic follow-up of bisphosphonate-associated atypical femur fractures.
abstract: OBJECTIVE
  To evaluate the appearance of bisphosphonate-related femur insufficiency fractures on long-term follow-up radiographic studies and to describe the rate of fracture line obscuration and cortical beak healing over time.
  
  
  METHODS
  In this retrospective study, bisphosphonate-related femur fracture radiographs were reviewed by two radiologists for the presence of a fracture line, callus, and the characteristic cortical beak. Kaplan-Meier curves were used to analyze the time to first indication of healing. Femurs were also subdivided into those who underwent early versus late surgical fixation and those who underwent early versus late discontinuation of bisphosphonate. Clinical data including pain level and medication history were collected.
  
  
  RESULTS
  Forty-seven femurs with a bisphosphonate-related femur fracture were identified in 28 women. Eighty-five percent took a bisphosphonate for greater than 5 years and 59 % for greater than 10 years. The median time to beak healing was 265 weeks and the median time to fracture line healing was 56 weeks in the 31 femurs with a baseline fracture. No statistically significant difference was identified between surgical fixation and conservative management.
  
  
  CONCLUSIONS
  Bisphosphonate-related fractures demonstrate notably prolonged healing time on long-term follow-up.
authors.affiliation: Department of Radiology, University of Washington, 1959 N.E. Pacific Street, Box 357115, Seattle, WA, 98195, USA.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Favinger
authors.affiliation: Department of Radiology, University of Washington, 850 Republication St, Seattle, WA, 98109, USA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Hippe
authors.affiliation: Department of Radiology, University of Washington, 4245 Roosevelt Way NE, Box 354755, Seattle, WA, 98105, USA. aha1@uw.edu.
authors.forename: Alice S
authors.initials: AS
authors.lastname: Ha
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D050071:Bone Density Conservation Agents / Q000009:adverse effects; D003937:Diagnosis, Differential; D004164:Diphosphonates / Q000009:adverse effects*; D005260:Female; D005264:Femoral Fractures / Q000139:chemically induced* / Q000000981:diagnostic imaging* / Q000628:therapy; D005500:Follow-Up Studies; D017102:Fracture Healing; D015775:Fractures, Stress / Q000139:chemically induced* / Q000000981:diagnostic imaging* / Q000628:therapy; D006801:Humans; D008137:Longitudinal Studies; D008875:Middle Aged; D011856:Radiographic Image Enhancement / Q000379:methods; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D016037:Single-Blind Method; D014057:Tomography, X-Ray Computed / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D050071:Bone Density Conservation Agents; D004164:Diphosphonates
keywords: Bisphosphonate; Femur; Fracture healing; Osteoporosis; Radiography