Atypical Fractures of the Femur Associated with Chronic Treatment with Bisphosphonates.
BACKGROUND
The problem of atypical fractures, such as subtrochanteric or diaphyseal femoral fractures, associated with long-term treatment with bisphosphonates (BPs) has recently been given increasingly more attention. These fractures develop as stress fractures and are characterised by diaphyseal cortical thickening and a transverse or slightly oblique fracture line. The use of bisphosphonates has been documented to reduce the risk of osteoporotic fractures. However, an increasing number of papers verify the safety and benefits of the administration of these drugs over more than 3-5 years.


METHODS
This paper presents 13 cases of atypical femoral fractures in 11 patients of the Department of Orthopaedics and Traumatology of the Musculoskeletal System of the Warsaw Medical University.


RESULTS
All patients had been taking BPs for a mean period of over 13 years (between 2 and 25 years) before the fracture.


CONCLUSIONS
1. The authors stress that these fractures differ from "classic" osteoporotic fractures. 2. The authors indicate surgical treatment of these fractures (even incomplete ones) as a method of choice. 3. The authors suggest that the need for further BP therapy should be assessed after 3-5 years of treatment.
Department of Orthopaedics and Traumatology of the Musculoskeletal System, 1st Medical Faculty, Warsaw Medical University, Warsaw, Poland.
Grzegorz
G
Fijewski
Department of Orthopaedics and Traumatology of the Musculoskeletal System, 1st Medical Faculty, Warsaw Medical University, Warsaw, Poland.
Bartłomiej
B
Szostakowski
Department of Orthopaedics and Traumatology of the Musculoskeletal System, 1st Medical Faculty, Warsaw Medical University, Warsaw, Poland.
Radosław
R
Górski
Department of Orthopaedics and Traumatology of the Musculoskeletal System, 1st Medical Faculty, Warsaw Medical University, Warsaw, Poland.
Piotr
P
Modzelewski
Department of Orthopaedics and Traumatology of the Musculoskeletal System, 1st Medical Faculty, Warsaw Medical University, Warsaw, Poland.
Piotr
P
Dudek
Department of Orthopaedics and Traumatology of the Musculoskeletal System, 1st Medical Faculty, Warsaw Medical University, Warsaw, Poland.
Paweł
P
Małdyk
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D050071:Bone Density Conservation Agents / Q000009:adverse effects* / Q000627:therapeutic use*; D004164:Diphosphonates / Q000009:adverse effects* / Q000627:therapeutic use*; D005260:Female; D005264:Femoral Fractures / Q000209:etiology*; D015775:Fractures, Stress / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000188:drug therapy*; D058866:Osteoporotic Fractures / Q000209:etiology*; D011044:Poland; D012307:Risk Factors
D050071:Bone Density Conservation Agents; D004164:Diphosphonates