Nicolaou N, Agrawal Y, Padman M, Fernandes J A, Bell M J
Department of Orthopaedics, Sheffield Children's Hospital, Western Bank, Sheffield, South Yorkshire UK.
J Child Orthop. 2012 Mar;6(1):21-7. doi: 10.1007/s11832-011-0380-0. Epub 2012 Jan 17.
Osteogenesis imperfecta (OI) has been treated with bisphosphonates for many years, with some clear clinical benefits. In adults, there are reports of a new pattern of atraumatic subtrochanteric fractures with bisphosphonate treatment. This study assesses if bisphosphonate treatment leads to an altered pattern of femoral fractures.
Retrospective review of imaging for a cohort of 176 bisphosphonate-treated OI patients to identify the locations of femoral fractures over a two-year period, as compared to a historical control group managed pre-bisphosphonates.
Sixteen femoral fractures were identified in this time period in the bisphosphonate-treated group. All but two were within the subtrochanteric region. In comparison, the historical group-composed of 26 femoral fractures-had a more widespread fracture pattern, with the most frequent location being the mid-diaphysis. Many of the subtrochanteric fractures in the treatment group occurred with minimal trauma.
It appears that concerns over the treatment of the adult osteoporotic population with bisphosphonates are amplified and mirrored in OI. It is possible that the high bending moments in the proximal femur together with altered mechanical properties of cortical bone secondary to the use of this group of drugs increase the risk of this type of injury, which warrants further modification of surgical management of the femur.
多年来一直使用双膦酸盐治疗成骨不全症（OI），并取得了一些明确的临床益处。在成人中，有报告称双膦酸盐治疗会出现一种新的非创伤性转子下骨折模式。本研究评估双膦酸盐治疗是否会导致股骨骨折模式发生改变。
回顾性分析176例接受双膦酸盐治疗的OI患者的影像学资料，以确定两年内股骨骨折的位置，并与双膦酸盐治疗前管理的历史对照组进行比较。
在双膦酸盐治疗组的这段时间内共发现16例股骨骨折。除两例外，其余均在转子下区域。相比之下，由26例股骨骨折组成的历史组骨折模式更为广泛，最常见的位置是骨干中部。治疗组中的许多转子下骨折发生时创伤极小。
看来，双膦酸盐治疗成年骨质疏松症患者的问题在OI中被放大并反映出来。股骨近端的高弯矩以及使用这类药物继发的皮质骨力学性能改变可能会增加这种损伤的风险，这值得对股骨手术管理进行进一步改进。
