Lockwood Matthew, Banderudrappagari Rajesh, Suva Larry J, Makhoul Issam
Division of Hematology/Oncology, Department of Internal Medicine, University of Arkansas for Medical Sciences, 4301 West Markham, Little Rock, AR, 72205, USA.
Department of Veterinary Physiology and Pharmacology, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, 4466 TAMU, College Station, TX, 77843-4466, USA.
J Bone Oncol. 2019 Aug 22;18:100259. doi: 10.1016/j.jbo.2019.100259. eCollection 2019 Oct.
Bisphosphonates are commonly used in patients with metastatic bone disease to prevent skeletal related events. Atypical femur fracture is a known complication of long-term bisphosphonate use but the incidence in cancer patients and pathogenesis are not well known. Several mechanisms of pathogenesis have been proposed including altered angiogenesis, altered bone mechanical properties, micro damage and bone remodeling suppression. Atypical femur fractures are atraumatic or minimally traumatic fractures in the sub trochanteric region or the femoral shaft. Awareness of atypical femur fractures is critical to diagnose and treat them in a timely manner. There is a paucity of data regarding the management of atypical femur fracture in patients with malignancy. Management options of atypical femur fractures include stopping bisphosphonates, initiating calcium/vitamin D supplementation and either surgery with internal fixation or conservative management. In the future, it will be important to explore the effect of continuous vs. intermittent exposure, cumulative dose and length of exposure on the incidence of this complication. Herein, we review the epidemiology, risk factors, management options and proposed mechanisms of pathogenesis of atypical femur fractures.
双膦酸盐常用于转移性骨病患者以预防骨相关事件。非典型股骨骨折是长期使用双膦酸盐已知的并发症，但癌症患者中的发生率及发病机制尚不清楚。已提出多种发病机制，包括血管生成改变、骨力学性能改变、微损伤及骨重塑抑制。非典型股骨骨折是转子下区域或股骨干的无创伤或微创伤骨折。认识非典型股骨骨折对于及时诊断和治疗至关重要。关于恶性肿瘤患者非典型股骨骨折的治疗，数据匮乏。非典型股骨骨折的治疗选择包括停用双膦酸盐、开始补充钙/维生素D以及手术内固定或保守治疗。未来，探究持续暴露与间歇暴露、累积剂量及暴露时长对该并发症发生率的影响将很重要。在此，我们综述非典型股骨骨折的流行病学、危险因素、治疗选择及发病机制。
