Collins Lucy, Ronan Alec, Hutcheon Evelyn, Ebeling Peter R, Grill Vivian, Nguyen Hanh H
Department of Medicine, School of Clinical Sciences, Monash University, 246 Clayton Road, Clayton, VIC, 3168, Australia.
Department of Endocrinology and Diabetes, Western Health, 176 Furlong Road, St Albans, VIC, 3021, Australia.
J Bone Miner Res. 2024 Nov 29;39(12):1722-1734. doi: 10.1093/jbmr/zjae159.
Osteoporosis is common, affecting more than 20% of women and 6% of men globally over the age of 50. Anti-resorptive drugs, bisphosphonates and denosumab, have been effective treatments for osteoporosis for more than 30 years. Rare complications of anti-resorptive therapy include medication-related osteonecrosis of the jaw and atypical femur fractures (AFF). The American Society for Bone and Mineral Research (ASBMR) proposed a case definition for these atypical femoral fractures in 2010, which was updated in 2013. However, atypical fractures at non-classical sites have been increasingly described. We aimed to systematically identify atypical fracture cases excluded from the ASBMR AFF case definition in patients receiving anti-resorptive medication for longer than 3 yr. A structured search of electronic databases, including PubMed, Medline (Ovid), Embase (Ovid), Cochrane, and Web of Sciences, and hand-searching of conference abstracts were undertaken. All full-text articles written in English describing an atypical fracture in patients (aged >18 yr) and receiving anti-resorptive medication for >3 yr were included, with data extracted and analyzed by two independent reviewers. Sixty-six articles were identified, describing 151 cases of atypical fractures in 114 individuals. The most frequent fracture site was the ulna, followed by the tibia. All patients were taking anti-resorptive treatment prior to or at the time of fracture, most frequently alendronate monotherapy (44%). Most commonly, fractures were transverse in nature (95%), following minimal or no trauma (96%), and non-comminuted (98%) with cortical thickening of the surrounding bone (69%). Anti-resorptive treatment was ceased following an atypical fracture in the majority (89%). Atypical fractures are rare and should not deter physicians from appropriate anti-resorptive therapy for osteoporosis. However, clinicians should be alert to their presence at additional sites to the femur. An update of the current ASBMR AFF case definition to include other skeletal sites could be timely.
骨质疏松症很常见，全球50岁以上的女性中有超过20%、男性中有6%受其影响。抗吸收药物、双膦酸盐和地诺单抗，已成为治疗骨质疏松症30多年来的有效方法。抗吸收治疗的罕见并发症包括药物相关的颌骨坏死和非典型股骨骨折（AFF）。美国骨与矿物质研究学会（ASBMR）在2010年提出了这些非典型股骨骨折的病例定义，并于2013年进行了更新。然而，非经典部位的非典型骨折的报道越来越多。我们旨在系统地识别在接受抗吸收药物治疗超过3年的患者中被排除在ASBMR AFF病例定义之外的非典型骨折病例。我们对电子数据库进行了结构化检索，包括PubMed、Medline（Ovid）、Embase（Ovid）、Cochrane和Web of Sciences，并对手检会议摘要进行了检索。纳入所有用英文撰写的全文文章，这些文章描述了患者（年龄>18岁）的非典型骨折且接受抗吸收药物治疗>3年，由两名独立的审阅者提取并分析数据。共识别出66篇文章，描述了114例个体中的151例非典型骨折病例。最常见的骨折部位是尺骨，其次是胫骨。所有患者在骨折前或骨折时均接受抗吸收治疗，最常见的是阿仑膦酸钠单药治疗（44%）。最常见的情况是，骨折本质上是横断性的（95%），发生在轻微或无创伤后（96%），且无粉碎性（98%），周围骨皮质增厚（69%）。大多数（89%）非典型骨折发生后停止了抗吸收治疗。非典型骨折很罕见，不应阻止医生对骨质疏松症进行适当的抗吸收治疗。然而，临床医生应警惕股骨以外其他部位出现非典型骨折。及时更新当前的ASBMR AFF病例定义以纳入其他骨骼部位可能是合适的。
