Background Bisphosphonates are a safe and effective treatment for osteoporotic disease, due to decreasing bone resorption mediated by osteoclasts. However, if the treatment lasts for 2–4 years, it may increase the formation and propagation of micro-cracks into the bone. As a result, patients may be susceptible to suffer atypical fractures, mainly in the subtrochanteric region and femoral shaft.
Purpose To analyse and assess the prevalence of atypical femur fractures in surgical patients treated with bisphosphonates.
Material and methods Descriptive observational study in a tertiary teaching hospital with 413 beds. We reviewed every inpatient of orthopaedic surgery from February 2013 until September 2014. Data collected included age, gender, domiciliary pharmacotherapy and medical history of the episode.
Results 585 surgery inpatients were studied, of which 34 (5.8%) had long-term bisphosphonate use for osteoporosis. 27 (79.5%) were female and 7 were male patients. The median age was 77 ± 9.5 years and the median duration of treatment was 17 ± 8.5 months.
Among patients reviewed, different bones were involved: 16 (47%) of them had femur fractures and 18 (53%) had other fractures: there were 11 patients with knee fracture (32.2%), 3 (8.8%) with shoulder fracture, 2 (5.9%) with wrist fracture, and the remaining patients had vertebral fractures. The average duration of treatment in patients with atypical femur fracture was 13 ± 3.2 months.
At the time of hospital discharge, 8 (23.5%) patients who had suffered some kind of fracture continued with bisphosphonate treatment, whereas 26 (76.5%) discontinued treatment at home.
Conclusion In our study, half of the patients who have been treated with long-term bisphosphonates suffered atypical femur fracture. Bisphosphonate treatment should be evaluated periodically by the primary care physician to prevent the occurrence of atypical fractures in patients with more than 12 months’ treatment.
ReferenceNo conflict of interest.
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