Lin Tsung-Li, Wang Shyu-Jye, Fong Yi-Chin, Hsu Chin-Jung, Hsu Horng-Chaung, Tsai Chun-Hao
Department of Orthopaedic Surgery, China Medical University Hospital, School of Medicine, China Medical University, Taichung, Taiwan.
BMC Res Notes. 2013 Jan 11;6:11. doi: 10.1186/1756-0500-6-11.
Long-term alendronate therapy may lead to atypical femoral fractures in a very few patients. However, the management protocol to optimize fracture healing remains undetermined. The purpose of this study was to describe the time to union of atypical femoral fractures after surgical nailing in patients on long-term alendronate therapy, with continuation of alendronate or discontinuation of alendronate, and administration of bone-forming agents.
From January 2004 to December 2011, the records of patients at our institution on long-term alendronate therapy for more than 36 months and sustaining atypical femoral fractures that had undergone surgical nailing, with continuation of alendronate or discontinuation of alendronate and administration of bone-forming agents were reviewed.During the 8-year study period, we treated 10 atypical femoral fractures with surgical nailing in 7 consecutive osteopenic or osteoporotic patients on long-term alendronate therapy for more than 36 months. There were no post-operative complications or needs for revision surgery. All fractures achieved union during follow-up. Mean union time was 23.5 months (range, 18-31 months) for 6 fractures with continuation of alendronate after surgery, and 4.5 months (range, 4-5 months) for 4 fractures with discontinuation of alendronate and administration of bone-forming agents after surgery.
Discontinuation of alendronate and administration of bone-forming agents after surgical nailing may promote union of atypical femoral fractures in patients on long-term alendronate therapy.
长期使用阿仑膦酸盐治疗可能会导致极少数患者发生非典型股骨骨折。然而，优化骨折愈合的管理方案仍未确定。本研究的目的是描述长期接受阿仑膦酸盐治疗的患者在手术钉合非典型股骨骨折后，继续使用或停用阿仑膦酸盐以及使用骨形成剂的情况下骨折愈合的时间。
回顾了2004年1月至2011年12月期间在我们机构接受长期阿仑膦酸盐治疗超过36个月且发生非典型股骨骨折并接受手术钉合的患者记录，这些患者继续使用或停用了阿仑膦酸盐并使用了骨形成剂。在8年的研究期间，我们对7名连续的骨质疏松或骨质减少患者进行了手术钉合治疗10例非典型股骨骨折，这些患者长期接受阿仑膦酸盐治疗超过36个月。术后无并发症，也无需翻修手术。所有骨折在随访期间均实现愈合。术后继续使用阿仑膦酸盐的6例骨折的平均愈合时间为23.5个月（范围为18 - 31个月）；术后停用阿仑膦酸盐并使用骨形成剂的4例骨折的平均愈合时间为4.5个月（范围为4 - 5个月）。
对于长期接受阿仑膦酸盐治疗的患者，手术钉合后停用阿仑膦酸盐并使用骨形成剂可能会促进非典型股骨骨折的愈合。
