Bhadada Sanjay Kumar, Sridhar Subbiah, Muthukrishnan Jeyaram, Mithal Ambrish, Sharma Dinesh C, Bhansali Anil, Dhiman Vandana
Department of Endocrinology, Postgraduate Institute of Medical Education & Research, Chandigarh, India.
Indian J Med Res. 2014 Jul;140(1):46-54.
BACKGROUND & OBJECTIVES: Bisphosphonates (BPs) are the most widely prescribed medicines for the treatment of osteoporosis because of their efficacy and favourable safety profile. There have been, several reports on an increased incidence of atypical femoral fractures after long term treatment with BPs. The objective of this study was to evaluate the clinical presentation including prodromal symptoms, skeletal radiograph findings, type and duration of BPs received and treatment outcome of patients who developed atypical femoral fractures during bisphosphonate therapy.
In this retrospective study, eight patients with atypical femoral fractures were analysed based on clinical features, biochemical and radiological investigations.
Of the eight patients, who sustained atypical femoral fractures, six were on alendronate and two were on zoledronate therapy before the fractures. In addition to BPs, two patients were on long term corticosteroid therapy for rheumatoid arthritis and Addison's disease. Three patients had bilateral atypical femoral fractures. Except one, all of them had prodromal symptoms prior to fracture. Skeletal radiograph showed cortical thickening, pointed (beaking of) cortical margin and transverse fracture in meta-diaphyseal location. Serum calcium, phosphate, alkaline phosphatase (ALP) and intact parathyroid hormone (iPTH) concentrations were within the reference range in all patients.
INTERPRETATION & CONCLUSIONS: Long term bisphosphonate therapy may increase the risk of atypical femoral fractures. Presence of prodromal pain, thickened cortex with cortical beaking may be an early clue for predicting the atypical fractures. High risk patients need periodical skeletal survey and a close follow up for early detection of cases.
双膦酸盐（BPs）因其疗效和良好的安全性，是治疗骨质疏松症最常用的药物。有几份报告指出，长期使用双膦酸盐治疗后非典型股骨骨折的发生率增加。本研究的目的是评估在双膦酸盐治疗期间发生非典型股骨骨折的患者的临床表现，包括前驱症状、骨骼X线检查结果、接受的双膦酸盐类型和持续时间以及治疗结果。
在这项回顾性研究中，根据临床特征、生化和影像学检查对8例非典型股骨骨折患者进行了分析。
在8例发生非典型股骨骨折的患者中，6例在骨折前接受阿仑膦酸盐治疗，2例接受唑来膦酸盐治疗。除双膦酸盐外，2例患者因类风湿性关节炎和艾迪生病接受长期皮质类固醇治疗。3例患者发生双侧非典型股骨骨折。除1例患者外，所有患者在骨折前均有前驱症状。骨骼X线检查显示皮质增厚、皮质边缘尖（喙状）和干骺端横形骨折。所有患者的血清钙、磷、碱性磷酸酶（ALP）和完整甲状旁腺激素（iPTH）浓度均在参考范围内。
长期双膦酸盐治疗可能会增加非典型股骨骨折的风险。前驱疼痛、皮质增厚伴皮质喙状改变可能是预测非典型骨折的早期线索。高危患者需要定期进行骨骼检查并密切随访，以便早期发现病例。
