Atypical Femur Fractures: A Case Report and Literature Review

Xiang Dian; Yang Yuhao; Lin Hongsheng

doi:doi:10.11648/j.cnn.20190304.14

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Atypical Femur Fractures: A Case Report and Literature Review

Xiang Dian, Yang Yuhao, Lin Hongsheng

Published in Clinical Neurology and Neuroscience (Volume 3, Issue 4)

Received: 9 November 2019 Accepted: 2 December 2019 Published: 10 December 2019

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Abstract

With the aging of the global population, osteoporosis has become a widespread phenomenon in the society. With the rapid increase of the number of osteoporotic fractures, a huge social and economic pressure has been caused. At the same time, it has attracted extensive attention. Bisphosphonates (BPs) can effectively prevent bone loss, improve bone density, and effectively reduce the incidence of osteoporotic fracture in the vertebral body and hip, which is the first choice for the treatment of osteoporosis. However, after tens of thousands of people take bisphosphonates for a long time, there are more and more reports of atypical femoral fractures (AFFs) caused by bisphosphonates, which cause the concerns of patients and doctors. The long-term use of bisphosphonates can promote the apoptosis of osteoclasts, inhibit the osteoclast's dissolution and absorption of bone trabecula, then reduce bone turnover, inhibit bone remodeling, lead to the accumulation of bone micro damage, and finally lead to fracture AFFs. We present an 83 year old woman who has been taking bisphosphonates for more than 10 years. The images indicate that there is nonunion in the middle and upper segments of both femurs. She was diagnosed as bilateral AFFS and was treated with plate and screw internal fixation for the left femur fracture and temporary conservative treatment for the right femur fracture. She was treated with anti infection, analgesia and circulation improvement after operation and the symptoms were relieved obviously and the effect was satisfactory. The case was reported as follows and reviews the related literature.

Published in	Clinical Neurology and Neuroscience (Volume 3, Issue 4)
DOI	10.11648/j.cnn.20190304.14
Page(s)	89-92
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2019. Published by Science Publishing Group

Keywords

Atypical Femoral Fractures, Bisphosphonates, Osteoporosis

References

[1]	Schilcher J, Koeppen V, Aspenberg P. Risk of atypical femoral fracture during and after bisphosphonate use. Acta Orthop. 2015. 83 (9): 1032-45.
[2]	Black DM, Abrahamsen B, Bouxsein ML, Einhorn T, Napoli N. Atypical Femur Fractures: Review of Epidemiology, Relationship to Bisphosphonates, Prevention, and Clinical Management. Endocr Rev. 2019. 40 (2): 333-368.
[3]	Selga J, Nuñez JH, Minguell J, Lalanza M, Garrido M. Simultaneous bilateral atypical femoral fracture in a patient receiving denosumab: case report and literature review. Osteoporos Int. 2016. 27 (2): 827-32.
[4]	Paparodis R, Buehring B, Pelley EM, Binkley N. A case of an unusual subtrochanteric fracture in a patient receiving denosumab. Endocr Pract. 2013. 19 (3): e64-8.
[5]	Shane E, Burr D, Ebeling PR. Atypical subtrochanteric and diaphyseal femoral fractures: report of a task force of the American Society for Bone and Mineral Research. J Bone Miner Res. 2010. 25 (11): 2267-94.
[6]	Einhorn TA, Bogdan Y, Tornetta P. Bisphosphonate-associated fractures of the femur: pathophysiology and treatment. J Orthop Trauma. 2014. 28 (7): 433-8.
[7]	Schilcher J, Aspenberg P. Incidence of stress fractures of the femoral shaft in women treated with bisphosphonate. Acta Orthop. 2009. 80 (4): 413-5.
[8]	McClung M, Harris ST, Miller PD. Bisphosphonate therapy for osteoporosis: benefits, risks, and drug holiday. Am J Med. 2013. 126 (1): 13-20.
[9]	Neviaser AS, Lane JM, Lenart BA, Edobor-Osula F, Lorich DG. Low-energy femoral shaft fractures associated with alendronate use. J Orthop Trauma. 2008. 22 (5): 346-50.
[10]	Bauer DC, Black DM, Bouxsein ML. Treatment-Related Changes in Bone Turnover and Fracture Risk Reduction in Clinical Trials of Anti-Resorptive Drugs: A Meta-Regression. J Bone Miner Res. 2018. 33 (4): 634-642.
[11]	Shane E, Burr D, Abrahamsen B. Atypical subtrochanteric and diaphyseal femoral fractures: second report of a task force of the American Society for Bone and Mineral Research. J Bone Miner Res. 2014. 29 (1): 1-23.
[12]	Black DM, Rosen CJ. Clinical Practice. Postmenopausal Osteoporosis. N Engl J Med. 2016. 374 (3): 254-62.
[13]	Dell RM, Adams AL, Greene DF. Incidence of atypical nontraumatic diaphyseal fractures of the femur. J Bone Miner Res. 2012. 27 (12): 2544-50.
[14]	Nakashima T, Hayashi M, Fukunaga T. Evidence for osteocyte regulation of bone homeostasis through RANKL expression. Nat Med. 2011. 17 (10): 1231-4.
[15]	Xiong J, Onal M, Jilka RL, Weinstein RS, Manolagas SC, O'Brien CA. Matrix-embedded cells control osteoclast formation. Nat Med. 2011. 17 (10): 1235-41.
[16]	Kayali C, Altay T, Ozan F, Sozkesen S, Yamak K. Atypical femoral shaft fractures secondary to long-term bisphosphonate therapy. J Orthop. 2017. 14 (2): 226-230.
[17]	Naylor KE, Jacques RM, Paggiosi M. Response of bone turnover markers to three oral bisphosphonate therapies in postmenopausal osteoporosis: the TRIO study. Osteoporos Int. 2016. 27 (1): 21-31.
[18]	Lim SJ, Yeo I, Yoon PW. Incidence, risk factors, and fracture healing of atypical femoral fractures: a multicenter case-control study. Osteoporos Int. 2018. 29 (11): 2427-2435.

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APA Style

Xiang Dian, Yang Yuhao, Lin Hongsheng. (2019). Atypical Femur Fractures: A Case Report and Literature Review. Clinical Neurology and Neuroscience, 3(4), 89-92. https://doi.org/10.11648/j.cnn.20190304.14

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ACS Style

Xiang Dian; Yang Yuhao; Lin Hongsheng. Atypical Femur Fractures: A Case Report and Literature Review. Clin. Neurol. Neurosci. 2019, 3(4), 89-92. doi: 10.11648/j.cnn.20190304.14

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AMA Style

Xiang Dian, Yang Yuhao, Lin Hongsheng. Atypical Femur Fractures: A Case Report and Literature Review. Clin Neurol Neurosci. 2019;3(4):89-92. doi: 10.11648/j.cnn.20190304.14

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@article{10.11648/j.cnn.20190304.14,
  author = {Xiang Dian and Yang Yuhao and Lin Hongsheng},
  title = {Atypical Femur Fractures: A Case Report and Literature Review},
  journal = {Clinical Neurology and Neuroscience},
  volume = {3},
  number = {4},
  pages = {89-92},
  doi = {10.11648/j.cnn.20190304.14},
  url = {https://doi.org/10.11648/j.cnn.20190304.14},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.cnn.20190304.14},
  abstract = {With the aging of the global population, osteoporosis has become a widespread phenomenon in the society. With the rapid increase of the number of osteoporotic fractures, a huge social and economic pressure has been caused. At the same time, it has attracted extensive attention. Bisphosphonates (BPs) can effectively prevent bone loss, improve bone density, and effectively reduce the incidence of osteoporotic fracture in the vertebral body and hip, which is the first choice for the treatment of osteoporosis. However, after tens of thousands of people take bisphosphonates for a long time, there are more and more reports of atypical femoral fractures (AFFs) caused by bisphosphonates, which cause the concerns of patients and doctors. The long-term use of bisphosphonates can promote the apoptosis of osteoclasts, inhibit the osteoclast's dissolution and absorption of bone trabecula, then reduce bone turnover, inhibit bone remodeling, lead to the accumulation of bone micro damage, and finally lead to fracture AFFs. We present an 83 year old woman who has been taking bisphosphonates for more than 10 years. The images indicate that there is nonunion in the middle and upper segments of both femurs. She was diagnosed as bilateral AFFS and was treated with plate and screw internal fixation for the left femur fracture and temporary conservative treatment for the right femur fracture. She was treated with anti infection, analgesia and circulation improvement after operation and the symptoms were relieved obviously and the effect was satisfactory. The case was reported as follows and reviews the related literature.},
 year = {2019}
}

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TY - JOUR
T1 - Atypical Femur Fractures: A Case Report and Literature Review
AU - Xiang Dian
AU - Yang Yuhao
AU - Lin Hongsheng
Y1 - 2019/12/10
PY - 2019
N1 - https://doi.org/10.11648/j.cnn.20190304.14
DO - 10.11648/j.cnn.20190304.14
T2 - Clinical Neurology and Neuroscience
JF - Clinical Neurology and Neuroscience
JO - Clinical Neurology and Neuroscience
SP - 89
EP - 92
PB - Science Publishing Group
SN - 2578-8930
UR - https://doi.org/10.11648/j.cnn.20190304.14
AB - With the aging of the global population, osteoporosis has become a widespread phenomenon in the society. With the rapid increase of the number of osteoporotic fractures, a huge social and economic pressure has been caused. At the same time, it has attracted extensive attention. Bisphosphonates (BPs) can effectively prevent bone loss, improve bone density, and effectively reduce the incidence of osteoporotic fracture in the vertebral body and hip, which is the first choice for the treatment of osteoporosis. However, after tens of thousands of people take bisphosphonates for a long time, there are more and more reports of atypical femoral fractures (AFFs) caused by bisphosphonates, which cause the concerns of patients and doctors. The long-term use of bisphosphonates can promote the apoptosis of osteoclasts, inhibit the osteoclast's dissolution and absorption of bone trabecula, then reduce bone turnover, inhibit bone remodeling, lead to the accumulation of bone micro damage, and finally lead to fracture AFFs. We present an 83 year old woman who has been taking bisphosphonates for more than 10 years. The images indicate that there is nonunion in the middle and upper segments of both femurs. She was diagnosed as bilateral AFFS and was treated with plate and screw internal fixation for the left femur fracture and temporary conservative treatment for the right femur fracture. She was treated with anti infection, analgesia and circulation improvement after operation and the symptoms were relieved obviously and the effect was satisfactory. The case was reported as follows and reviews the related literature.
VL - 3
IS - 4
ER -

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Author Information

Xiang Dian

Department of Orthopedics, The First Affiliated Hospital of Jinan University, Guangzhou, China
Yang Yuhao

Department of Orthopedics, The First Affiliated Hospital of Jinan University, Guangzhou, China
Lin Hongsheng

Department of Orthopedics, The First Affiliated Hospital of Jinan University, Guangzhou, China

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APA Style

Xiang Dian, Yang Yuhao, Lin Hongsheng. (2019). Atypical Femur Fractures: A Case Report and Literature Review. Clinical Neurology and Neuroscience, 3(4), 89-92. https://doi.org/10.11648/j.cnn.20190304.14

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ACS Style

Xiang Dian; Yang Yuhao; Lin Hongsheng. Atypical Femur Fractures: A Case Report and Literature Review. Clin. Neurol. Neurosci. 2019, 3(4), 89-92. doi: 10.11648/j.cnn.20190304.14

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AMA Style

Xiang Dian, Yang Yuhao, Lin Hongsheng. Atypical Femur Fractures: A Case Report and Literature Review. Clin Neurol Neurosci. 2019;3(4):89-92. doi: 10.11648/j.cnn.20190304.14

Copy | Download

@article{10.11648/j.cnn.20190304.14,
  author = {Xiang Dian and Yang Yuhao and Lin Hongsheng},
  title = {Atypical Femur Fractures: A Case Report and Literature Review},
  journal = {Clinical Neurology and Neuroscience},
  volume = {3},
  number = {4},
  pages = {89-92},
  doi = {10.11648/j.cnn.20190304.14},
  url = {https://doi.org/10.11648/j.cnn.20190304.14},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.cnn.20190304.14},
  abstract = {With the aging of the global population, osteoporosis has become a widespread phenomenon in the society. With the rapid increase of the number of osteoporotic fractures, a huge social and economic pressure has been caused. At the same time, it has attracted extensive attention. Bisphosphonates (BPs) can effectively prevent bone loss, improve bone density, and effectively reduce the incidence of osteoporotic fracture in the vertebral body and hip, which is the first choice for the treatment of osteoporosis. However, after tens of thousands of people take bisphosphonates for a long time, there are more and more reports of atypical femoral fractures (AFFs) caused by bisphosphonates, which cause the concerns of patients and doctors. The long-term use of bisphosphonates can promote the apoptosis of osteoclasts, inhibit the osteoclast's dissolution and absorption of bone trabecula, then reduce bone turnover, inhibit bone remodeling, lead to the accumulation of bone micro damage, and finally lead to fracture AFFs. We present an 83 year old woman who has been taking bisphosphonates for more than 10 years. The images indicate that there is nonunion in the middle and upper segments of both femurs. She was diagnosed as bilateral AFFS and was treated with plate and screw internal fixation for the left femur fracture and temporary conservative treatment for the right femur fracture. She was treated with anti infection, analgesia and circulation improvement after operation and the symptoms were relieved obviously and the effect was satisfactory. The case was reported as follows and reviews the related literature.},
 year = {2019}
}

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