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Management of Rare Femoral Fractures
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Posted on: 02/20/2013
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In this article, surgeons from the Hospital for Special Surgery in New York City present their recommendations for the management of atypical femoral fractures. As part of their focus, they review the influence of bisphosphonates on these rare fractures of the thigh bone.
A few definitions might help you understand the implications of their findings. First, atypical femoral fractures affect the long, shaft portion of the thigh bone (femur). The do not present or look like the more common osteoporotic bone fractures that older adults experience. But just exactly how to describe or define atypical femoral fractures has not been determined yet.
At the present time, the major features of atypical femoral fractures include: 1) the location (the long shaft of the bone), 2) type of fracture (across the bone on a diagonal), and 3) the way the fracture occurred (no trauma or very low trauma, like falling down from a standing position). A visible spike at one end of the fracture seen on X-rays is a tell-tale sign of these types of fractures.
The use of bisphosphonate medications for osteoporosis (brittle bones) has turned up as a possible risk factor for the atypical femoral fractures. These bone building drugs for osteoporosis stop the normal cycle of bone turnover. Over time, they can actually increase the risk of fracture. But studies with different results have been reported, so the debate and controversy over these drugs continues. Whether or not long-term use (defined as five years or more) is a cause of atypical femoral fractures is unknown.
Collection of data on femoral fractures show that the fractures currently described as "atypical" are unusual, if not rare. Physicians who are aware of the risk factors may not be able to keep them from occurring. But early recognition and management following the recommendations of these authors may help minimize poor results.
They say the first thing to do is stop the use of the bisphosphonates. This drug builds up in the bone and continues to be released for years after the patient has stopping taking them. And studies so far show no increase in fractures after discontinuing the medication compared to people of the same age group who never took the bisphosphonates.
Next, calcium and vitamin D supplements to aid the bone building process are advised. Lab tests should be done to look for any reason the bone might not heal. This could be a thyroid problem, metabolic bone disease, or hormone deficiency (e.g., low testosterone).
Other recommendations include surgical treatment for the fracture with a long nail down the center of the bone to stabilize the fracture. Other types of fixation may not be enough to hold the shape of the atypical fracture together until union takes place. Patients should be monitored closely for the same kind of fracture developing in the other leg. Up to 44 per cent of patients with the first atypical femoral fracture end up having the same thing happen to the other leg.
The authors conclude by saying when weighing the pros and cons of bisphosphonate therapy for osteoporosis, treatment with these drugs is still recommended. If an atypical femoral fracture develops, the patient can take a "drug holiday" (stop taking the medication for a while). It does not appear that doing so increases the risk of an osteoporotic fracture. However, as mentioned, the risk of another atypical femoral fracture on the other side remains high.
More study is needed to clearly identify risk factors and primary and secondary features of these rare atypical femoral fractures. This type of information would help physicians find more effective ways to prevent and treat them when they do occur.
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References:
Aasis Unnanuntana, MD, et al. Atypical Femoral Fractures: What Do We Know About Them? In The Journal of Bone and Joint Surgery. January 16, 2013. Vol. 95A. No. 2. Pp. e8(1)-13.
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*Disclaimer:*The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic. |
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