Department of Orthopaedic Surgery, College of Medicine, Inha University, 7-206, 3-ga, Sinhueng-dong, Jung-gu, Incheon, 400-711, Korea,
Int Orthop. 2014 Jun;38(6):1247-53. doi: 10.1007/s00264-013-2259-9. Epub 2014 Jan 25.
Increasing numbers of atypical femoral fractures have been reported among long-term bisphosphonate users. We evaluated clinical characteristics of atypical femoral fractures throughout Korean multicenter studies.
We retrospectively analysed the bone mineral density, prodromal symptoms before femoral fracture, and medication history of osteoporosis in 76 cases of atypical femoral fracture.
The mean age of cases was 71.4 ± 8.8 (range, 43-89) years old. The mean follow-up period after the fracture operation was 24.5 ± 12.9 (range, 12-79) months. BMI was 23.2 ± 3.0 on average. The mean BMD of femur was -1.9 ± 1.4 (range, -4.8 to 1.3). Prodromal symptoms including thigh pain before femoral fracture appeared in 22 (28.9 %) of 76 patients. All patients included in the study used bisphosphonate. The duration of taking bisphosphonate before fracture was 36.8 ± 50.8 (one-204 months) months. Fifty-seven (75 %) of 76 patients were taking the medication for more than three years. Delayed union occurred in 43 (56.5 %) of 76 patients. Delayed union was defined as a fractured bone that did not completely heal within six months of injury. The group of having taken anti-osteoporotic medication for more than three years showed relatively longer union period compared to that for a shorter period medication group (4.8 ± 2.5 months vs 9.3 ± 3.7 months, p = 0.017). The delayed union developed in 43 (56.5 %) of 76 patients and showed a significantly higher incidence in the group with long-term therapy (five/43 vs 38/43, p = 0.021). The bilateral femoral fractures developed in 23 (30.2 %) of 76 patients and showed a high incidence in the group medicated more than three years (two/23 vs 21/23, p = 0.039).
The longer bisphosphonates are used, the more the cases of delayed union and the more frequent the development of bilateral fractures following unilateral fractures. With regard to the delayed union, the methods of the acceleration of fracture healing may be beneficial in atypical femoral fracture patients who had been receiving long-term bisphosphonates therapy. Careful observation is required for contra-lateral femurs due to a high incidence of bilateral atypical femoral fractures.
长期使用双膦酸盐的患者中，报告了越来越多的非典型股骨骨折。我们通过韩国多中心研究评估了非典型股骨骨折的临床特征。
我们回顾性分析了 76 例非典型股骨骨折患者的骨密度、股骨骨折前的前驱症状和骨质疏松症的用药史。
病例的平均年龄为 71.4±8.8（范围，43-89）岁。骨折手术后的平均随访时间为 24.5±12.9（范围，12-79）个月。平均 BMI 为 23.2±3.0。股骨的平均 BMD 为-1.9±1.4（范围，-4.8 至 1.3）。22 例（28.9%）76 例患者在股骨骨折前出现大腿疼痛前驱症状。所有纳入研究的患者均使用双膦酸盐。骨折前使用双膦酸盐的时间为 36.8±50.8（1-204）个月。57（75%）例 76 例患者的服药时间超过 3 年。76 例患者中有 43 例（56.5%）出现延迟愈合。延迟愈合定义为受伤后 6 个月内骨折未完全愈合。与服药时间较短的患者相比，服药时间超过 3 年的患者愈合时间相对较长（4.8±2.5 个月 vs 9.3±3.7 个月，p=0.017）。76 例患者中有 43 例（56.5%）出现延迟愈合，长期治疗组的发生率明显更高（5/43 例 vs 38/43 例，p=0.021）。76 例患者中有 23 例（30.2%）发生双侧股骨骨折，服药时间超过 3 年的患者发生率较高（2/23 例 vs 21/23 例，p=0.039）。
双膦酸盐使用时间越长，延迟愈合的发生率越高，单侧骨折后双侧骨折的发生率越高。对于延迟愈合，加速骨折愈合的方法可能对长期接受双膦酸盐治疗的非典型股骨骨折患者有益。由于双侧非典型股骨骨折的发生率较高，因此需要对对侧股骨进行仔细观察。
