Egol Kenneth A, Park Ji Hae, Rosenberg Zehava Sadka, Peck Valerie, Tejwani Nirmal C
Department of Orthopaedic Surgery, New York University Hospital for Joint Diseases, 301 E 17th Street, New York, NY, 10003, USA,
Clin Orthop Relat Res. 2014 Sep;472(9):2728-34. doi: 10.1007/s11999-013-2963-1.
Bisphosphonate therapy for osteoporosis has been associated with atypical femoral fractures. To date, there have been few reports in the literature regarding the preoperative and postoperative courses of patients who have sustained bisphosphonate-associated complete atypical femur fractures.
OBJECTIVES/PURPOSES: The purposes of this study were to (1) characterize the preoperative course of patients who eventually presented with bisphosphonate-associated complete atypical femur fractures (duration of bisphosphonate treatment, pain history, risk of converting a nondisplaced fracture to a complete fracture); (2) evaluate the percentage of patients who achieved radiographic union of those fractures after treatment; and (3) determine the patients' recovery of function using the Short Musculoskeletal Functional Assessment.
Thirty-three patients with 41 atypical, low-energy femur fractures associated with ≥ 5 years of bisphosphonate use were treated with intramedullary nailing between 2004 and 2011 at one center. The main outcome measurements were Short Musculoskeletal Functional Assessment for function and radiographic evaluation for fracture healing. Patients had been treated with bisphosphonates for an average of 8.8 years (range, 5-20 years) before presentation.
Patients reported a mean of 6 months of pain before presentation (range, 1-8 months). Sixty-six percent of patients with surgically treated complete fractures became pain-free and 98% were radiographically healed by 12 months. Sixty-four percent of patients who underwent intramedullary nailing reported a functional return to baseline within 1 year. Patients who reported major functional limitations at latest followup listed pain and apprehension as the major causes of their limitation.
Patients with surgically treated bisphosphonate-associated complete femur fractures achieved generally reliable although delayed fracture healing if malaligned, and nearly two-thirds of patients returned to self-reported baseline function within 1 year.
Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
双膦酸盐治疗骨质疏松症与非典型股骨骨折有关。迄今为止，关于双膦酸盐相关完全性非典型股骨骨折患者术前和术后病程的文献报道很少。
本研究的目的是：（1）描述最终出现双膦酸盐相关完全性非典型股骨骨折患者的术前病程（双膦酸盐治疗持续时间、疼痛史、无移位骨折转变为完全骨折的风险）；（2）评估治疗后骨折获得影像学愈合的患者百分比；（3）使用简短肌肉骨骼功能评估确定患者的功能恢复情况。
2004年至2011年期间，在一个中心对33例使用双膦酸盐≥5年且发生41例非典型、低能量股骨骨折的患者进行了髓内钉固定治疗。主要结局指标为功能的简短肌肉骨骼功能评估和骨折愈合的影像学评估。患者在出现症状前平均接受双膦酸盐治疗8.8年（范围5 - 20年）。
患者报告出现症状前平均疼痛6个月（范围1 - 8个月）。接受手术治疗的完全骨折患者中，66%的患者疼痛消失，98%的患者在12个月时影像学愈合。接受髓内钉固定的患者中，64%报告在1年内功能恢复至基线水平。在最近一次随访中报告有主要功能受限的患者将疼痛和担忧列为受限的主要原因。
接受手术治疗的双膦酸盐相关完全性股骨骨折患者，骨折愈合虽延迟但总体可靠，若骨折对位不良则愈合延迟，近三分之二的患者在1年内恢复至自我报告的基线功能水平。
III级，治疗性研究。有关证据水平的完整描述，请参阅作者指南。
