1
|
Anderson PA, Kates SL, Watts ND. Update on Atypical Femoral Fractures. J Bone Joint Surg Am 2024:00004623-990000000-01182. [PMID: 39172879 DOI: 10.2106/jbjs.23.01439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/24/2024]
Abstract
➤ Atypical femoral fractures (AFFs) are stress fractures between the lesser trochanter and the metaphyseal flare that are most commonly related to prolonged (3 to 5 years) antiresorptive medication use.➤ An important finding is a visible transverse line in the lateral cortex, known as the "dreaded black line." Complete fractures are transverse and have minimal comminution.➤ Prodromal symptoms including hip, groin, thigh, and knee pain are present in more than one-half of cases and are usually misdiagnosed.➤ Nonoperative treatment for all patients with AFF includes withdrawal of bisphosphonates, assessment for secondary causes of osteoporosis, and optimization of vitamin D and calcium.➤ Incomplete fractures without a visible line can initially be treated nonoperatively with protected weight-bearing.➤ Intramedullary nailing is indicated for complete fractures and incomplete fractures with a visible fracture line. Delayed healing after fixation should be anticipated.➤ Treatment with parathyroid hormone (PTH) analogs (teriparatide and abaloparatide) after AFF prevents other fractures in high-risk patients, but the effect on healing of the fracture is unclear.
Collapse
Affiliation(s)
- Paul A Anderson
- Department of Orthopedics and Rehabilitation, University of Wisconsin, Madison, Wisconsin
| | - Stephen L Kates
- Department of Orthopaedic Surgery, Virginia Commonwealth University, Richmond, Virginia
| | - Nelson D Watts
- Osteoporosis and Bone Health Services, Mercy Health, Cincinnati, Ohio
| |
Collapse
|
2
|
Bliemel C, Birkelbach R, Knauf T, Pass B, Craiovan B, Schoeneberg C, Ruchholtz S, Bäumlein M. Surgical management and outcomes following atypical subtrochanteric femoral fractures - results from a matched-pair analysis of the registry for geriatric trauma of the German Trauma Society. Arch Orthop Trauma Surg 2024; 144:2561-2572. [PMID: 38642159 PMCID: PMC11211164 DOI: 10.1007/s00402-024-05297-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 03/24/2024] [Indexed: 04/22/2024]
Abstract
BACKGROUND AND OBJECTIVES The outcomes of patients with atypical subtrochanteric fractures (ASFs) remain unclear. Data from a large international geriatric trauma registry were analysed to examine the outcome of patients with ASFs compared to patients with typical osteoporotic subtrochanteric fractures (TSFs). MATERIALS AND METHODS Data from the Registry for Geriatric Trauma of the German Trauma Society (Deutsche Gesellschaft für Unfallchirurgie [DGU]) (ATR-DGU) were analysed. All patients treated surgically for ASFs or TSFs were included in this analysis. Across both fracture types, a paired matching approach was conducted, where statistical twins were formed based on background characteristics sex, age, American Society of Anesthesiologists (ASA) score and walking ability. In-house mortality and mortality rates at the 120-day follow-up, as well as mobility at 7 and 120 days, the reoperation rate, hospital discharge management, the hospital readmission rate at the 120-day follow-up, health-related quality of life, type of surgical treatment and anti-osteoporotic therapy at 7 and 120 days, were assessed as outcome measures using a multivariate logistic regression analysis. RESULTS Amongst the 1,800 included patients, 1,781 had TSFs and 19 had ASFs. Logistic regression analysis revealed that patients with ASFs were more often treated with closed intramedullary nailing (RR = 3.59, p < 0.001) and had a higher probability of vitamin D supplementation as osteoporosis therapy at 120 days (RR = 0.88, p < 0.002). Patients with ASFs were also more likely to live at home after surgery (RR = 1.43, p < 0.001), and they also tended to continue living at home more often than patients with TSFs (RR = 1.33, p < 0.001). Accordingly, patients with TSFs had a higher relative risk of losing their self-sufficient living status, as indicated by increased rates of patients living at home preoperatively and being discharged to nursing homes (RR = 0.19, p < 0.001) or other hospitals (RR = 0.00, p < 0.001) postoperatively. CONCLUSIONS Surgical treatment of ASFs was marked by more frequent use of closed intramedullary fracture reduction. Furthermore, patients with ASFs were more likely to be discharged home and died significantly less often in the given timeframe. The rate of perioperative complications, as indicated by nonsignificant reoperation rates, as well as patient walking abilities during the follow-up period, remained unaffected.
Collapse
Affiliation(s)
- Christopher Bliemel
- Center for Orthopaedics and Trauma Surgery, University Hospital Marburg, 35043, Baldingerstrasse, Marburg, Germany.
- Philipps University of Marburg, Marburg, Germany.
| | | | - Tom Knauf
- Center for Orthopaedics and Trauma Surgery, University Hospital Marburg, 35043, Baldingerstrasse, Marburg, Germany
| | - Bastian Pass
- Department of Orthopedic and Emergency Surgery, Alfried Krupp Hospital, Essen, Germany
| | - Benjamin Craiovan
- Center for Orthopaedics and Trauma Surgery, University Hospital Marburg, 35043, Baldingerstrasse, Marburg, Germany
| | - Carsten Schoeneberg
- Department of Orthopedic and Emergency Surgery, Alfried Krupp Hospital, Essen, Germany
| | - Steffen Ruchholtz
- Center for Orthopaedics and Trauma Surgery, University Hospital Marburg, 35043, Baldingerstrasse, Marburg, Germany
- Philipps University of Marburg, Marburg, Germany
| | - Martin Bäumlein
- Center for Orthopaedics and Trauma Surgery, University Hospital Marburg, 35043, Baldingerstrasse, Marburg, Germany
- Philipps University of Marburg, Marburg, Germany
| |
Collapse
|
3
|
Kline GA, Morin SN, Lix LM, Leslie WD. A Population-Based Registry Study of Extended Bisphosphonate Use: Minimal Shift After Landmark Publications About Shorter Treatment Duration. J Bone Miner Res 2023; 38:1435-1442. [PMID: 37462900 DOI: 10.1002/jbmr.4885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 06/27/2023] [Accepted: 07/14/2023] [Indexed: 08/15/2023]
Abstract
Optimal duration of bisphosphonate therapy was unknown until the FLEX study was published in 2006 showing a 5-year course to be adequate for most women. In 2008, a link between long-term bisphosphonate and atypical femoral fractures was reported and confirmed in later studies. We hypothesized these landmark observations should have led to a decrease in use of bisphosphonates for >5 or 10 years, from 2010 onward. The Manitoba Bone Mineral Density (BMD) Registry with linkage to provincial pharmacy data was used to determine the percentage of long- and very long-term bisphosphonate users from therapy start. The cohort comprised women aged >50 years with BMD between 1995 and 2018 with oral bisphosphonate first prescribed for >90 days with adherence >75% in the first year. For each calendar year of continued therapy, the percentage of patients and medication possession rate was tabulated. The percentage of users beyond 5 years was compared among patients who started therapy in 1998-2004 (those taking 5 years of therapy still finish before 2010) versus 2005-2012 (all new therapy starts overlap 2010 in those taking ≥5 years of treatment). The cohort included 2991 women with mean follow-up 8.8 (1.3) years, 64.9% of whom took continuous oral bisphosphonate for >5 years and 41.9% for >10 years. In the earlier versus later era, there were 74.4% versus 70.2% who completed 5 years. With respect to longer treatment, there were 68.0% and 60.5% of patients treated for 6 or more years (p < 0.0001) and 46.6% versus 33.5% treated for >10 years (p = 0.08). Medication possession rate was >79% in every year of therapy. Landmark studies leading to more limited bisphosphonate courses may have slightly reduced longer-term treatment, but up to one-third of adherent patients in the modern era still receive continuous bisphosphonate therapy for >10 years. © 2023 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).
Collapse
Affiliation(s)
- Gregory A Kline
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | | | - Lisa M Lix
- Department of Community Health Science, University of Manitoba, Winnipeg, Canada
| | - William D Leslie
- Department of Community Health Science, University of Manitoba, Winnipeg, Canada
- Departments of Medicine and Radiology, University of Manitoba, Winnipeg, Canada
| |
Collapse
|
4
|
Foessl I, Dimai HP, Obermayer-Pietsch B. Long-term and sequential treatment for osteoporosis. Nat Rev Endocrinol 2023; 19:520-533. [PMID: 37464088 DOI: 10.1038/s41574-023-00866-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/21/2023] [Indexed: 07/20/2023]
Abstract
Osteoporosis is a skeletal disorder that causes impairment of bone structure and strength, leading to a progressively increased risk of fragility fractures. The global prevalence of osteoporosis is increasing in the ageing population. Owing to the chronic character of osteoporosis, years or even decades of preventive measures or therapy are required. The long-term use of bone-specific pharmacological treatment options, including antiresorptive and/or osteoanabolic approaches, has raised concerns around adverse effects or potential rebound phenomena after treatment discontinuation. Imaging options, risk scores and the assessment of bone turnover during initiation and monitoring of such therapies could help to inform individualized treatment strategies. Combination therapies are currently used less often than 'sequential' treatments. However, all patients with osteoporosis, including those with secondary and rare causes of osteoporosis, as well as specific patient populations (for example, young adults, men and pregnant women) require new approaches for long-term therapy and disease monitoring. New pathophysiological aspects of bone metabolism might therefore help to inform and revolutionize the diagnosis and treatment of osteoporosis.
Collapse
Affiliation(s)
- Ines Foessl
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University Graz, Graz, Austria
| | - Hans P Dimai
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University Graz, Graz, Austria
| | - Barbara Obermayer-Pietsch
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University Graz, Graz, Austria.
| |
Collapse
|
5
|
Gharanizadeh K, Ravanbod H, Aminian A, Hatami S, Chaleshtori AS, Kazerani S. Acetabular and sacral insufficiency fractures in a patient with a long-term history of Alendronate consumption; a case report. BMC Musculoskelet Disord 2023; 24:211. [PMID: 36949509 PMCID: PMC10031978 DOI: 10.1186/s12891-023-06327-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 03/13/2023] [Indexed: 03/24/2023] Open
Abstract
BACKGROUND Long-term Bisphosphonate consumption has been reported to be associated with the incidence of atypical or insufficiency fracture, particularly in the proximal femur. We observed a case of acetabular and sacral insufficiency fractures in a patient with a long-term history of Alendronate consumption. CASE PRESENTATION A 62-year-old woman was admitted with a complaint of pain in right lower limb following low-energy trauma. The patient had a history of Alendronate consumption for more than 10 years. The bone scan revealed increased radiotracer uptake in the right side of the pelvic, proximal right femur, and sacroiliac joint. The radiographs showed type 1 sacrum fracture, acetabulum fracture with femur head protrusion into the pelvis, quadrilateral surface fracture, fracture of the right anterior column, and right superior and inferior pubic fracture. The patient was treated with total hip arthroplasty. CONCLUSION This case highlights the concerns regarding long-term bisphosphonate therapy and its potential complications.
Collapse
Affiliation(s)
- Kaveh Gharanizadeh
- Shafa Orthopedic Hospital, Iran University of Medical Science, Tehran, Iran
- Bone and Joint Reconstruction Research Center, Department of Orthopedics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Hadi Ravanbod
- Shafa Orthopedic Hospital, Iran University of Medical Science, Tehran, Iran.
- Bone and Joint Reconstruction Research Center, Department of Orthopedics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.
- Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran.
| | - Amir Aminian
- Bone and Joint Reconstruction Research Center, Department of Orthopedics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Saeed Hatami
- Department of Orthopedic Surgery, School of Medicine, Isfahan University of Medical Science, Isfahan, Iran
| | - Ali Sherafati Chaleshtori
- Department of Orthopedic Surgery, School of Medicine, Isfahan University of Medical Science, Isfahan, Iran
| | - Soroush Kazerani
- Department of Orthopedic Surgery, School of Medicine, Isfahan University of Medical Science, Isfahan, Iran
| |
Collapse
|
6
|
Nitrogen-Containing Bisphosphonates Downregulate Cathepsin K and Upregulate Annexin V in Osteoclasts Cultured In Vitro. Int J Dent 2023; 2023:2960941. [PMID: 36866025 PMCID: PMC9974278 DOI: 10.1155/2023/2960941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 01/12/2023] [Accepted: 01/19/2023] [Indexed: 02/23/2023] Open
Abstract
Introduction Bisphosphonates are widely used in the treatment of osteoporosis; however, they are associated with the serious adverse event of bisphosphonate-related osteonecrosis of the jaw (BRONJ). Aim The aim of this study is to assess the effects of nitrogen-containing bisphosphonates (N-PHs) on the synthesis of IL-1β, TNF-α, sRANKL, cathepsin K, and annexin V in bone cells cultured in vitro. Materials and Methods Osteoblasts and bone marrow-derived osteoclasts were cultured in vitro, subjected to treatment with alendronate, risedronate, or ibandronate at a concentration of 10-5 M for 0 to 96 h and then assayed for IL-1β, sRANKL, and TNF-α production by ELISA. Cathepsin K and Annexin V-FITC staining in osteoclasts were assessed by flow cytometry. Results There was significant downregulation of IL-1β, sRANKL, and TNF-α in experimental osteoblasts compared to control cells, and there was upregulation of IL-1β and downregulation of RANKL and TNF-α in experimental osteoclasts. Furthermore, in osteoclasts, cathepsin K expression was downregulated at 48-72 h with alendronate treatment, while risedronate treatment resulted in upregulated annexin V expression at 48 h compared to the control treatment. Conclusion Bisphosphonates added to bone cells inhibited osteoclastogenesis, which led to the downregulation of cathepsin K and induction of apoptosis in osteoclasts; these changes limited the capacity of bone remodelling and healing that may contribute to BRONJ induced by surgical dental procedures.
Collapse
|
7
|
Tsuchiya K, Okano I, Shiose K, Kudo Y, Hayakawa C, Kuroda T, Toyone T, Inagaki K. Atypical femoral fracture mimicking lumbar radiculopathy in two patients taking bisphosphonate long-term: A case report. BMC Musculoskelet Disord 2022; 23:1103. [PMID: 36528778 PMCID: PMC9758855 DOI: 10.1186/s12891-022-05990-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 11/15/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Atypical femoral fracture (AFF) is a rare complication in patients with osteoporosis undergoing long-term bisphosphonate therapy. The most common symptom of incomplete AFF is nonspecific thigh pain, which is often difficult to distinguish from other causes. CASE PRESENTATION We present two cases of AFF misdiagnosed as lumbar radiculopathy. Both patients visited our hospital for thigh pain, and in both cases the findings of lumbar spine magnetic resonance imaging showed substantial nerve compression. These patients had been treated for lumbar radiculopathy, but localized symptoms became conspicuous and femoral radiographs revealed complete AFF. The initial radiographs were reviewed retrospectively and revealed slight lateral cortical thickening in the affected femur, denoting a missed incomplete AFF. Internal fixation with intramedullary nails was performed. CONCLUSIONS AFF may mimic lumbar radiculopathy. Therefore, clinicians should consider AFF as a differential diagnosis in older patients with lumbar canal stenosis who are undergoing long-term bisphosphonate therapy and present with thigh pain.
Collapse
Affiliation(s)
- Koki Tsuchiya
- grid.410714.70000 0000 8864 3422Department of Orthopaedic Surgery, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa, Tokyo, 142-8666 Japan ,Department of Orthopaedic Surgery, Yamanashi Red Cross Hospital, 6663-1 Funatsu, Fujikawaguchiko, Yamanashi, 401-0301 Japan
| | - Ichiro Okano
- grid.410714.70000 0000 8864 3422Department of Orthopaedic Surgery, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa, Tokyo, 142-8666 Japan
| | - Katsuyuki Shiose
- grid.410714.70000 0000 8864 3422Department of Orthopaedic Surgery, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa, Tokyo, 142-8666 Japan
| | - Yoshifumi Kudo
- grid.410714.70000 0000 8864 3422Department of Orthopaedic Surgery, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa, Tokyo, 142-8666 Japan
| | - Chikara Hayakawa
- grid.410714.70000 0000 8864 3422Department of Orthopaedic Surgery, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa, Tokyo, 142-8666 Japan
| | - Takuma Kuroda
- grid.410714.70000 0000 8864 3422Department of Orthopaedic Surgery, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa, Tokyo, 142-8666 Japan
| | - Tomoaki Toyone
- grid.410714.70000 0000 8864 3422Department of Orthopaedic Surgery, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa, Tokyo, 142-8666 Japan
| | - Katsunori Inagaki
- grid.410714.70000 0000 8864 3422Department of Orthopaedic Surgery, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa, Tokyo, 142-8666 Japan
| |
Collapse
|
8
|
Fuggle N, Al-Daghri N, Bock O, Branco J, Bruyère O, Casado E, Cavalier E, Cortet B, de Wit M, Giusti A, Halbout P, Harvey NC, Hiligsmann M, Kaufman JM, Kurth A, Maggi S, Matijevic R, Minisola S, Palacios S, Radermecker RP, Thomasius F, Tuzun S, Veronese N, Kanis JA, Reginster JY, Rizzoli R, Cooper C. Novel formulations of oral bisphosphonates in the treatment of osteoporosis. Aging Clin Exp Res 2022; 34:2625-2634. [PMID: 36331798 PMCID: PMC9675642 DOI: 10.1007/s40520-022-02272-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 10/03/2022] [Indexed: 11/06/2022]
Abstract
Oral bisphosphonates are a key intervention in the treatment of osteoporosis and in reducing the risk of fragility fractures. Their use is supported by over 3 decades of evidence; however, patient adherence to oral bisphosphonates remains poor in part due to complex dosing instructions and adverse events, including upper gastrointestinal symptoms. This problem has led to the development of novel oral bisphosphonate formulations. Buffered, effervescent alendronate is dissolved in water and so seeks to reduce upper gastro-intestinal adverse events, and gastro-resistant risedronate aims to reduce the complexity of dosing procedure (e.g. fasting prior to consumption) whilst still maintaining the efficacy of fracture risk reduction. Clinical trials and real-world data have been employed to demonstrate some benefits in terms of reduced upper gastro-intestinal adverse events, adherence, persistence and health economic outcomes. This report describes the result of an ESCEO (European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis) expert working group, which explores where oral bisphosphonates sit in current clinical practice guidelines, review their risk-benefit profile and the consequences of poor adherence before exploring novel oral bisphosphonate formulations and their potential clinical and health economic impact. Further research is required but there are signs that these novel, oral bisphosphonate formulations may lead to improved tolerance of oral bisphosphonates and thus, improved adherence and fracture outcomes.
Collapse
Affiliation(s)
- Nicholas Fuggle
- MRC Lifecourse Epidemiology Centre, University of Southampton, Tremona Road, Southampton, SO16 6YD, UK
| | - Nasser Al-Daghri
- Chair for Biomarkers of Chronic Diseases, Biochemistry Department, College of Science, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Olivier Bock
- Department of Osteoporosis, Inselspital-Bern University Hospital, University of Bern, Bern, Switzerland
- International Osteoporosis Foundation, Nyon, Switzerland
| | - Jaime Branco
- Centro Hospitalar de Lisboa Ocidental-Hospital Egas Moniz, CEDOC/NOVA Medical School, Nova University of Lisbon, Lisbon, Portugal
| | - Olivier Bruyère
- Division of Public Health, Epidemiology and Health Economics, WHO Collaborating Center for Public Health Aspects of Musculo-Skeletal Health and Ageing, University of Liège, Avenue Hippocrate 13, CHU B23, 4000, Liege, Belgium
| | - Enrique Casado
- Department of Rheumatology, University Hospital Parc Taulí, I3PT Research Institute (UAB), Sabadell, Barcelona, Spain
| | - Etienne Cavalier
- Department of Clinical Chemistry, University of Liège, CIRM, CHU Sart-Tilman, 4000, Liège, Belgium
| | - Bernard Cortet
- Department of Rheumatology, Univ. Lille, CHU Lille, MABlab ULR 4490, 59000, Lille, France
| | - Maarten de Wit
- Department of Medical Humanities, Amsterdam University Medical Centre, Amsterdam, The Netherlands
| | - Andrea Giusti
- Metabolic Bone Diseases Unit and Fracture Liaison Service, Rheumatology Unit, Department of Medical Specialties, Local Health Trust 3, Via Missolungi 14, 16147, Genoa, Italy
| | | | - Nicholas C Harvey
- MRC Lifecourse Epidemiology Centre, University of Southampton, Tremona Road, Southampton, SO16 6YD, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, UK
| | - Mickaël Hiligsmann
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Jean-Marc Kaufman
- Department of Endocrinology, Ghent University Hospital, 9000, Ghent, Belgium
| | - Andreas Kurth
- Department of Orthopaedic and Trauma Surgery, Community Clinics Middle Rhine, Campus Kemperhof, Koblenz, Germany
| | - Stefania Maggi
- Institute of Neuroscience, Aging Branch, CNR, Padua, Italy
| | - Radmila Matijevic
- Faculty of Medicine, Clinic for Orthopedic Surgery and Traumatology, Clinical Center of Vojvodina, University of Novi Sad, Novi Sad, Serbia
| | - Salvatore Minisola
- Department of Clinical, Internal, Anaesthesiology, and Cardiovascular Sciences, Sapienza University of Rome, 00185, Rome, Italy
| | | | - Régis Pierre Radermecker
- Department of Diabetes, Nutrition and Metabolic Disorders, Clinical Pharmacology, University of Liège, CHU de Liège, Liège, Belgium
| | | | - Sansin Tuzun
- Department of Physical Medicine and Rehabilitation, Cerrahpaşa Medical Faculty, Istanbul University Cerrahpaşa, Istanbul, Turkey
| | - Nicola Veronese
- Department of Internal Medicine, Geriatrics Section, University of Palermo, Palermo, Italy
| | - John A Kanis
- Mary McKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
- Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK
| | - Jean-Yves Reginster
- Centro Hospitalar de Lisboa Ocidental-Hospital Egas Moniz, CEDOC/NOVA Medical School, Nova University of Lisbon, Lisbon, Portugal
| | - René Rizzoli
- Department of Osteoporosis, Inselspital-Bern University Hospital, University of Bern, Bern, Switzerland
| | - Cyrus Cooper
- MRC Lifecourse Epidemiology Centre, University of Southampton, Tremona Road, Southampton, SO16 6YD, UK.
- Department of Rheumatology, Univ. Lille, CHU Lille, MABlab ULR 4490, 59000, Lille, France.
- NIHR Musculoskeletal Biomedical Research Unit, University of Oxford, Oxford, UK.
| |
Collapse
|
9
|
Aparisi Gómez MP, Aparisi F, Morganti AG, Fanti S, Bazzocchi A. Effects of Radiation Therapy and Chemotherapy on the Musculoskeletal System. Semin Musculoskelet Radiol 2022; 26:338-353. [PMID: 35654099 DOI: 10.1055/s-0041-1740995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The effects of radiation and chemotherapy on the musculoskeletal (MSK) system are diverse, and interpretation may be challenging. The different lines of treatment have effects on diseased and normal marrow, and they may lead to complications that must be differentiated from recurrence or progression. This review analyzes the changes induced by radiotherapy and chemotherapy in the MSK system in the adult and pediatric population, and the expected associated imaging findings. Treatments are often combined, so the effects may blend. Awareness of the spectrum of changes, complications, and their imaging appearances is paramount for the correct diagnosis. The assessment of body composition during and after treatment allows potential interventions to implement long-term outcomes and personalize treatments. Imaging techniques such as computed tomography or magnetic resonance imaging provide information on body composition that can be incorporated into clinical pathways. We also address future perspectives in posttreatment assessment.
Collapse
Affiliation(s)
- Maria Pilar Aparisi Gómez
- Department of Radiology, Auckland City Hospital, Auckland, New Zealand.,Department of Radiology, IMSKE, Valencia, Spain
| | - Francisco Aparisi
- Department of Radiology, Hospital Vithas Nueve de Octubre, Valencia, Spain
| | - Alessio Giuseppe Morganti
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, University of Bologna, Bologna, Italy.,Department of Experimental, Diagnostic and Specialty Medicine - DIMES, Alma Mater Studiroum Bologna University, Bologna, Italy
| | - Stefano Fanti
- Department of Experimental, Diagnostic and Specialty Medicine - DIMES, Alma Mater Studiroum Bologna University, Bologna, Italy.,Nuclear Medicine Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, University of Bologna, Bologna, Italy
| | - Alberto Bazzocchi
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| |
Collapse
|
10
|
Spanyer J, Barber LA, Lands H, Brown A, Bouxsein M, Heng M, Yakkanti M. Health-related quality of life outcomes after surgical treatment of atypical femur fractures: a multicenter retrospective cohort study. JBMR Plus 2021; 5:e10514. [PMID: 34761142 PMCID: PMC8567490 DOI: 10.1002/jbm4.10514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 04/24/2021] [Accepted: 04/27/2021] [Indexed: 11/10/2022] Open
Abstract
The objective of this study was to examine the health-related quality of life (HRQOL) outcomes for surgically-treated atypical femur fractures (AFFs) compared to typical femoral diaphyseal fractures. Two large trauma center databases were retrospectively queried for surgically-treated femur fractures. Fractures were grouped into AFFs and compared to a control cohort. Controls for the AFF group included women with diaphyseal fractures without additional AFF characteristics. Patients were contacted for administration of the Short Form-36v2 Health Survey. Surveys were completed an average of 30.3 months (range, 6-138 months) and 25.5 months (range, 5-77 months) postoperatively for the AFF and non-AFF groups, respectively. All patients were female, with 46 patients in the AFF and 26 patients in the non-AFF group. The average age of the AFF group was 70.1 years compared with an average age of 67.4 years in the non-AFF group (p = 0.287). Over 90% (91.3%) of patients in the AFF group had a history of bisphosphonate use while 26.9% of patients in the non-AFF group had used bisphosphonates (p < 0.0001). Patients with AFF reported their postoperative physical and mental health to be no different than similarly aged patients with femoral diaphyseal fractures, as measured by the Short Form 36, version 2 (SF-36v2) Health Survey. These data suggest that mid-term patient-reported quality of life outcomes are similar among women who sustain an AFF compared to a cohort of more typical femoral diaphyseal fractures. © 2021 The Authors. JBMR Plus published by Wiley Periodicals LLC. on behalf of American Society for Bone and Mineral Research.
Collapse
Affiliation(s)
| | - Lauren A Barber
- Hospital for Special Surgery Orthopaedic Surgery New York New York USA
| | - Harrison Lands
- Dartmouth-Hitchcock Health System Lebanon New Hampshire USA
| | - Alexander Brown
- Andrews Sports Medicine and Orthopaedic Center Birmingham Alabama USA
| | - Mary Bouxsein
- Center for Advanced Orthopedic Studies, Beth Israel Deaconess Medical Center Boston Massachusetts USA
| | - Marilyn Heng
- Orthopaedic Trauma Surgery Massachusetts General Hospital Boston Massachusetts USA
| | | |
Collapse
|
11
|
Onafowokan OO. Atypical bilateral femoral fractures: a rare adverse effect of long-term bisphosphonate use. BMJ Case Rep 2021; 14:e246156. [PMID: 34479909 PMCID: PMC8420656 DOI: 10.1136/bcr-2021-246156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/19/2021] [Indexed: 11/03/2022] Open
|
12
|
Ali MA, Ali FMH. A Woman With Hip Pain. Ann Emerg Med 2021; 78:229-241. [PMID: 34325857 DOI: 10.1016/j.annemergmed.2021.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Indexed: 11/30/2022]
Affiliation(s)
- M Adam Ali
- Department of Trauma and Orthopaedics, Royal Free Hospital, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Fatima M H Ali
- Department of Breast Surgery, Northwick Park Hospital, London North West University Healthcare NHS Trust, Harrow, United Kingdom
| |
Collapse
|
13
|
Papapoulos S, Bone H, Cosman F, Dempster DW, McClung MR, Nakamura T, Restrepo JFM, Bouxsein ML, Cohn D, de Papp A, Massaad R, Santora A. Incidence of Hip and Subtrochanteric/Femoral Shaft Fractures in Postmenopausal Women With Osteoporosis in the Phase 3 Long-Term Odanacatib Fracture Trial. J Bone Miner Res 2021; 36:1225-1234. [PMID: 33724542 DOI: 10.1002/jbmr.4284] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 03/01/2021] [Accepted: 03/08/2021] [Indexed: 12/23/2022]
Abstract
We prospectively assessed, with predefined criteria, the location and rates of all femur fractures (hip, subtrochanteric/femoral shaft [ST/FS], including atypical [AFF] and distal fractures) in women at increased fracture risk during treatment with the cathepsin K inhibitor, odanacatib (ODN), or placebo over 5 years in the Long-Term ODN Fracture Trial (LOFT and LOFT Extension [NCT00529373, EudraCT 2007-002693-66]). ODN was an investigational antiresorptive agent previously in development as an osteoporosis treatment that, unlike bisphosphonates, reduces bone formation only transiently. Women aged ≥65 years with a bone mineral density (BMD) T-score ≤-2.5 at the total hip (TH) or femoral neck (FN) or with a radiographic vertebral fracture and T-scores ≤-1.5 at the TH or FN were randomized (1:1) to receive ODN 50 mg/week or placebo. All patients received vitamin D3 (5600 IU/week) and calcium (total 1200 mg/d); the analysis included 16,071 women. Rates of all adjudicated low-energy femoral fractures were 0.38 versus 0.58/100 patient-years for ODN and placebo, respectively (hazard ratio [HR] = 0.65; 95% confidence interval [CI] 0.51-0.82; nominal p < .001), and for low-energy hip fractures were 0.29 versus 0.56/100 patient-years, respectively (HR = 0.52; 95% CI 0.40-0.67; p < .001). The cumulative incidence of combined hip and ST/FS or hip fractures alone in the ODN group was consistently lower than in the placebo group (1.93% versus 3.11% for combined fractures and 1.53% versus 3.03% for hip fractures at 5 years, respectively). However, low-energy ST/FS fractures were more frequent in ODN-treated women than in placebo-treated women (24 versus 6, respectively). Among these, 12 fractures were adjudicated as AFF in 10 patients treated with ODN (0.03/100 patient-years) compared with none in the 6 placebo-treated women (estimated difference 0.03; 95% CI 0.02-0.06). These results provide insight into possible pathogeneses of AFF, suggesting that the current criteria for diagnosing these fractures may need to be reconsidered. © 2021 American Society for Bone and Mineral Research (ASBMR)..
Collapse
Affiliation(s)
| | - Henry Bone
- Michigan Bone & Mineral Clinic, Detroit, MI, USA
| | | | | | - Michael R McClung
- Oregon Osteoporosis Center, Portland, OR, USA.,Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
| | | | | | - Mary L Bouxsein
- Center for Advanced Orthopedic Studies, Beth Israel Deaconess Medical Center, and Department of Orthopedic Surgery, Harvard Medical School, Boston, MA, USA
| | | | | | | | | |
Collapse
|
14
|
Napoli N. Atypical Femur Fractures: Another Piece to the Puzzle? J Bone Miner Res 2021; 36:1029-1030. [PMID: 34000090 DOI: 10.1002/jbmr.4332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 05/05/2021] [Accepted: 05/06/2021] [Indexed: 11/07/2022]
Affiliation(s)
- Nicola Napoli
- Unit of Endocrinology and Diabetes, Departmental Faculty of Medicine and Surgery, Campus Bio-Medico University of Rome, Rome, Italy.,Division of Bone and Mineral Diseases, Washington University in ST Louis, St Louis, MO, USA
| |
Collapse
|
15
|
Aki T, Hashimoto K, Uozumi H, Saito M, Sugawara K, Suzuki M, Hamada S, Ito A, Itoi E. Morphological and Morphometrical Analyses of Fracture-Healing Sites of an Atypical Femoral Fracture in Patients with and without Long-Term Bisphosphonate Treatment for Osteoporosis: A Report of Two Cases. TOHOKU J EXP MED 2021; 253:261-267. [PMID: 33853993 DOI: 10.1620/tjem.253.261] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Bisphosphonates have been the first drug of choice for osteoporosis in the recent years because of their known ability to suppress osteoclast activity. The adverse effect of long-term bisphosphonate administration in the fracture-healing process is controversial. The aim of our study was to observe not only morphology but also morphometry of the fracture site of atypical femoral fracture with and without long-term bisphosphonate administration, in a case study of two difficult-to-obtain human samples. The patients with insufficient healing of atypical femoral fracture were treated with valgus wedge osteotomy. Histomorphometrical analysis was performed in bone samples of fracture sites harvested during osteotomy. The thickness of the femoral cortex was measured in the fracture site and the adjacent, non-fracture site. A comparative analysis of the content of hypertrophic osteoclasts in fracture sites, shape and size of osteons, mass, and ratio of the woven bone to the total bone mass was performed, comparing bisphosphonate-treated and untreated samples. In bisphosphonate-treated samples, we observed femoral cortex thickening at the fracture site; the appearance of hypertrophic osteoclasts; decreased bone resorption surface, decreased osteoclast numbers on the bone resorption surface, and increased ratio of multinuclear osteoclasts; osteons were misshapen and thin; and the mass and ratio of the woven bone to the total bone mass were higher. This study demonstrated that long-term bisphosphonate administration can alter the morphological features of the fracture site compared to its physiological state.
Collapse
Affiliation(s)
- Takashi Aki
- Department of Orthopaedic Surgery, Tohoku University Graduate School of Medicine
| | - Ko Hashimoto
- Department of Orthopaedic Surgery, Tohoku University Graduate School of Medicine
| | | | | | | | - Manabu Suzuki
- Department of Orthopaedic Surgery, Tohoku University Graduate School of Medicine
| | - Soshi Hamada
- Department of Orthopaedic Surgery, Tohoku University Graduate School of Medicine
| | | | - Eiji Itoi
- Department of Orthopaedic Surgery, Tohoku University Graduate School of Medicine
| |
Collapse
|
16
|
Muthu S, Ramakrishnan E, Chellamuthu G. 'Bone within bone appearance' in a pathological fracture. BMJ Case Rep 2020; 13:13/12/e238567. [PMID: 33370952 PMCID: PMC7754666 DOI: 10.1136/bcr-2020-238567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
A 60-year-old man presented to our hospital with complaints of pain and deformity on his right thigh for the past 2 days following a history of accidental slip and fall. Radiological investigations suggested a pathological type 2 Seinsheimer subtrochanteric fracture of the right femur with a 'bone within bone' appearance, which posed a diagnostic dilemma as this radiological appearance is seen in a spectrum of conditions. Radiographic skeletal survey failed to identify a similar appearance elsewhere in the body. Laboratory investigations pointed in favour of bone mineral disease, and histopathological examination of the bone narrowed it down to Paget's disease. The fracture was fixed with a contralateral distal femur locking compression plate. The fracture site failed to show signs of union until 6 months postsurgery and hence the patient was advised for grafting procedure. The patient deferred surgery and remains without major complications until 18 months of follow-up.
Collapse
Affiliation(s)
- Sathish Muthu
- Velayuthampalayam Government Hospital, Velayuthampalayam, Tamil Nadu, India
- Orthopaedic Research Group, Coimbatore, Tamil Nadu, India
| | - Eswar Ramakrishnan
- Orthopaedic Research Group, Coimbatore, Tamil Nadu, India
- Institute of Orthopaedics and Traumatology, Madras Medical College, Chennai, Tamil Nadu, India
| | - Girinivasan Chellamuthu
- Orthopaedic Research Group, Coimbatore, Tamil Nadu, India
- Department of Orthopaedic Surgery, Ganga Medical Centre and Hospitals, Coimbatore, Tamil Nadu, India
| |
Collapse
|
17
|
Canbek U, Akgun U, Soylemez D, Canbek TD, Aydogan NH. Incomplete atypical femoral fractures after bisphosphonate use in postmenopausal women. J Orthop Surg (Hong Kong) 2020; 27:2309499019875262. [PMID: 31547771 DOI: 10.1177/2309499019875262] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE This study aimed to determine the prevalence of incomplete atypical femoral fractures (iAFFs) in postmenopausal women using bisphosphonates and to investigate the potential risk factors for the development of iAFF. METHODS The national health-care records system indicated that 2746 postmenopausal women in our region aged ≥50 years were taking bisphosphonates. Using an assumed iAFF prevalence of 10% and levels of 5% α significance and ±5% precision, we calculated that a sample size of 132 participants was needed for this study. The patients were randomly selected and invited to the hospital. Radiographs and bone scans were used to evaluate each patient for iAFF. Bone mineral density, 25-hydroxy vitamin D, parathyroid hormone, and alkaline phosphatase measurements were performed. RESULTS The mean age of the study population was 72.79 ± 7.35 years, and the mean duration of bisphosphonate use was 7.7 ± 3.4 years. We found iAFF in 14 (10.6%) patients, and 3 patients had bilateral involvement. Of the 17 femurs with iAFF, a proximal third location was seen in 2 patients (11.8%), a mid-third location in 14 (82.4%), and a distal third location in 1 (5.9%). The duration of bisphosphonate use was longer, and parathyroid hormone levels were higher in patients with iAFF compared to those without an incomplete fracture. CONCLUSION We found a relatively higher prevalence of iAFF in postmenopausal women using bisphosphonate. Early identification and treatment of iAFF is crucial for reducing potential patient morbidity and hospital costs.
Collapse
Affiliation(s)
- Umut Canbek
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Mugla Sitki Kocman University, Mugla, Turkey
| | - Ulas Akgun
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Mugla Sitki Kocman University, Mugla, Turkey
| | - Deniz Soylemez
- Department of Nuclear Medicine, Mugla Sitki Kocman University Training and Research Hospital, Mugla, Turkey
| | - Tugba Dubektas Canbek
- Department of Internal Medicine, Mugla Sitki Kocman University Training and Research Hospital, Mugla, Turkey
| | - Nevres Hurriyet Aydogan
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Mugla Sitki Kocman University, Mugla, Turkey
| |
Collapse
|
18
|
Cheng X, Zhu Z, Liu Y, Xue Y, Gao X, Wang J, Pei X, Wan Q. Zeolitic Imidazolate Framework-8 Encapsulating Risedronate Synergistically Enhances Osteogenic and Antiresorptive Properties for Bone Regeneration. ACS Biomater Sci Eng 2020; 6:2186-2197. [PMID: 33455339 DOI: 10.1021/acsbiomaterials.0c00195] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Bisphosphonates (BPs) are routinely administered for the treatment of turnover bone diseases. To avoid the undesirable adverse effects of long-term usage of bisphosphonates and improve their bioavailability in the bone microenvironment, we initially encapsulated risedronate (RIS) molecules inside nanoscale zeolitic imidazolate framework-8 particles (nZIF-8) by a one-step synthesis method to generate RIS@ZIF-8 nanoparticles. RIS@ZIF-8 nanoparticles displayed high loading encapsulation efficiency (64.21 ± 2.48%), good biocompatibility, controlled drug release capacity, and dual effects for bone regeneration. This work explored the potential of RIS@ZIF-8 nanoparticles, which could not only enhance ATP production, induce extracellular matrix (ECM) mineralization, and upregulate the expression levels of osteogenic genes but also effectively inhibit the formation of multinucleated giant osteocasts and decrease the Rankl/Opg ratio. Overall, RIS@ZIF-8 nanoparticles could be a very promising approach to synergistically enhance osteogenic and antiresorptive properties for bone regeneration, which could be utilized for the local treatment of bone defects.
Collapse
Affiliation(s)
- Xinting Cheng
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Prosthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan 610041, China
| | - Zhou Zhu
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Prosthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan 610041, China
| | - Yanhua Liu
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Prosthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan 610041, China
| | - Yiyuan Xue
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Prosthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan 610041, China
| | - Xiaomeng Gao
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Prosthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan 610041, China
| | - Jian Wang
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Prosthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan 610041, China
| | - Xibo Pei
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Prosthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan 610041, China
| | - Qianbing Wan
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Prosthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan 610041, China
| |
Collapse
|
19
|
Theodora P, Apostolos P, Vasileios P, Sofia K, Eva-Maria D, Antonia S. Histologic evaluation of femoral nerve demyelinating and axonal neuropathy in Wistar rats due to alendronate intake: a randomised study. ACTA ACUST UNITED AC 2020; 27:2. [PMID: 32099834 PMCID: PMC7029514 DOI: 10.1186/s40709-020-0112-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 02/06/2020] [Indexed: 02/04/2023]
Abstract
Background Bisphosphonates (BPs) are forceful inhibitors of osteoclast-mediated bone resorption. Long-term BP use is associated with multiple rare but severe adverse effects. The objective of this study was to investigate the possible effects of BPs in the structure of femoral nerve. Specimens from the femoral nerve of ten female 12-month old Wistar rats were used as control group and ten female 12-month old Wistar rats to which Alendronate (Fosamax, Merck) was administered per os for 13 weeks, were used as research group. Samples were observed under a Transmission Electron Microscope. G ratio measurements and statistical analysis with SPSS program were also performed. Results The control group showed no major changes of the nerve's histologic image, with the exception of some spots of thickness of the nerve myelin sheath. The research group showed major morphological changes which varied from partial disorganization or thickening of the myelin to severe myelin thickening and axon strangulation. A statistically significant difference of the G ratio between the two groups was observed. Conclusions The reported values (found in literature) for the morphologic measurements of the femoral nerve in Wistar rats are not complying with the ones we found in our study. There was a significant reduction of all three variables (the mean axon like diameter, the myelin thickness, G ratio) studied in the femoral nerve of the research group in contrast to control group. Our study demonstrates a possible correlation between alendronate administration and femoral nerve's function, nevertheless due to the small specimen further research is needed.
Collapse
Affiliation(s)
- Papamitsou Theodora
- Laboratory of Histology and Embryology, Faculty of Medicine, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| | - Papakoulas Apostolos
- Laboratory of Histology and Embryology, Faculty of Medicine, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| | - Papaliagkas Vasileios
- Laboratory of Histology and Embryology, Faculty of Medicine, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| | - Karachrysafi Sofia
- Laboratory of Histology and Embryology, Faculty of Medicine, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| | - Dietrich Eva-Maria
- Laboratory of Histology and Embryology, Faculty of Medicine, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| | - Sioga Antonia
- Laboratory of Histology and Embryology, Faculty of Medicine, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| |
Collapse
|
20
|
PHARMACOLOGICAL MANAGEMENT OF OSTEOPOROSIS IN POSTMENOPAUSAL WOMEN: THE CURRENT STATE OF THE ART. JOURNAL OF POPULATION THERAPEUTICS AND CLINICAL PHARMACOLOGY 2019. [DOI: 10.15586/jptcp.v26i4.646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
|
21
|
Shin WC, Moon NH, Jang JH, Seo HU, Suh KT. A retrospective bicenter comparative study of surgical outcomes of atypical femoral fracture: Potential effect of teriparatide on fracture healing and callus formation. Bone 2019; 128:115033. [PMID: 31398503 DOI: 10.1016/j.bone.2019.08.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 07/22/2019] [Accepted: 08/05/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND The main purpose of the present study was to assess the radiologic effect of teriparatide on fracture healing, including union rate, union time, and callus formation, by quantitative measurements using serial follow-up X-ray imaging examinations in patients with complete atypical femoral fractures (AFFs) treated using closed intramedullary nailing. METHODS From January 2010 to October 2017, 58 consecutive patients with complete AFF who were treated with intramedullary nailing at two institutions were enrolled. Patients were classified into two groups: those who received teriparatide therapy (group A) and those who did not (group B). Teriparatide (Forsteo®; Eli Lily Co., Indianapolis, IN, USA) at a once-daily 20 μg dose was prescribed as continuous treatment of osteoporosis or with the expectation of better bone healing. Surgical outcomes, including union rate, union time, modified radiologic union score (mRUS), and callus formation at 3, 6, and 12 months postoperatively, were assessed to evaluate the effect of teriparatide on fracture healing. Quantitative measurement of callus formation was performed using the region of interest (ROI) tool in the picture archiving communication system (PACS). RESULTS Non-union was not observed in group A, whereas two patients had non-union in group B. Union time was 18.3 ± 4.8 (range, 12-28) weeks in group A and 23.6 ± 9.5 (range, 12-64) weeks in group B and was significantly shorter in group A than group B (p = 0.010). The average mRUSs during periods A (3-4 months postoperatively), B (6-8 months postoperatively), and C (12-14 months postoperatively) were 10.0, 13.9, and 15.9 in group A, and 8.7, 12.0, and 14.9 in group B, respectively. The average mRUSs during periods A and B were significantly different (p = 0.027 and 0.011, respectively). The medial, posterior, and total callus areas during periods A and B were also significantly greater in group A than in group B. No difference was observed in the union rate between the two groups (p = 0.492). CONCLUSION Teriparatide may improve callus formation and shorten union time in patients with complete diaphyseal AFF who underwent closed intramedullary nailing. LEVEL OF EVIDENCE Level III retrospective comparative study.
Collapse
Affiliation(s)
- Won Chul Shin
- Department of Orthopaedic Surgery, Pusan National University Yangsan Hospital
| | - Nam Hoon Moon
- Department of Orthopaedic Surgery, Bio-medical Research Institute, Pusan National University Hospital.
| | - Jae Hoon Jang
- Department of Orthopaedic Surgery, Bio-medical Research Institute, Pusan National University Hospital
| | - Han Ul Seo
- Department of Orthopaedic Surgery, Bio-medical Research Institute, Pusan National University Hospital
| | - Kuen Tak Suh
- Department of Orthopaedic Surgery, Pusan National University Yangsan Hospital
| |
Collapse
|
22
|
Jiang HT, Ran CC, Liao YP, Zhu JH, Wang H, Deng R, Nie M, He BC, Deng ZL. IGF-1 reverses the osteogenic inhibitory effect of dexamethasone on BMP9-induced osteogenic differentiation in mouse embryonic fibroblasts via PI3K/AKT/COX-2 pathway. J Steroid Biochem Mol Biol 2019; 191:105363. [PMID: 31018166 DOI: 10.1016/j.jsbmb.2019.04.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 03/19/2019] [Accepted: 04/09/2019] [Indexed: 02/08/2023]
Abstract
Glucocorticoid-Induced Osteoporosis (GIOP) is a prevalent clinical complication caused by large dose administration of glucocorticoids, such as Dexamethasone (Dex) and Prednisone. GIOP may lead to fractures and even Osteonecrosis of the Femoral Head (ONFH). It has been reported that glucocorticoids inhibit osteogenesis via the suppression of osteogenic differentiation in Mesenchymal Stem Cells (MSCs), but the precise mechanism underlying this suppression awaits further investigation. Meanwhile, novel and efficacious therapies are recommended to cope with GIOP. In this study, we demonstrated that Dex had the inhibitory effect on Bone Morphogenetic Protein 9 (BMP9)-induced ALP activities and matrix mineralization in Mouse Embryonic Fibroblasts (MEFs). In addition, the study confirmed that Dex decreased the expression of osteogenic markers such as Runx2 and OPN. However, the inhibitory effect of Dex on these osteogenic markers can be reversed when combined with insulin-like growth factor 1 (IGF-1). Regarding the inhibitory mechanism, we found that the level of AKT and p-AKT can be decreased by Dex and that Ly294002, the PI3K inhibitor, can block the reversal effect of IGF-1. Moreover, the knockdown or inhibition of COX-2 produced similar results to those of Ly294002. Our findings indicated that IGF-1 may reverse the osteogenic inhibitory effect of Dex via PI3K/AKT pathway, which may be associated with the up-regulation of COX-2. This study may provide new clinical management strategy for GIOP cases.
Collapse
Affiliation(s)
- Hai-Tao Jiang
- Department of Orthopaedics, The Second Affiliated Hospital of Chongqing Medical University, 76 Linjiang Road, Yuzhong District, Chongqing 400010, PR China; Chongqing Key Laboratory of Biochemistry and Molecular Pharmacology, Chongqing Medical University, No. 1 Yixueyuan Road, Yuzhong District, Chongqing 400010, PR China
| | - Cheng-Cheng Ran
- Department of Orthopaedics, The Second Affiliated Hospital of Chongqing Medical University, 76 Linjiang Road, Yuzhong District, Chongqing 400010, PR China; Chongqing Key Laboratory of Biochemistry and Molecular Pharmacology, Chongqing Medical University, No. 1 Yixueyuan Road, Yuzhong District, Chongqing 400010, PR China
| | - Yun-Peng Liao
- Chongqing Key Laboratory of Biochemistry and Molecular Pharmacology, Chongqing Medical University, No. 1 Yixueyuan Road, Yuzhong District, Chongqing 400010, PR China; Department of Pharmacology, School of Pharmacy, Chongqing Medical University, No. 1 Yixueyuan Road, Yuzhong District, Chongqing 400010, PR China
| | - Jia-Hui Zhu
- Chongqing Key Laboratory of Biochemistry and Molecular Pharmacology, Chongqing Medical University, No. 1 Yixueyuan Road, Yuzhong District, Chongqing 400010, PR China; Department of Pharmacology, School of Pharmacy, Chongqing Medical University, No. 1 Yixueyuan Road, Yuzhong District, Chongqing 400010, PR China
| | - Han Wang
- Chongqing Key Laboratory of Biochemistry and Molecular Pharmacology, Chongqing Medical University, No. 1 Yixueyuan Road, Yuzhong District, Chongqing 400010, PR China; Department of Pharmacology, School of Pharmacy, Chongqing Medical University, No. 1 Yixueyuan Road, Yuzhong District, Chongqing 400010, PR China
| | - Rui Deng
- Department of Orthopaedics, The Second Affiliated Hospital of Chongqing Medical University, 76 Linjiang Road, Yuzhong District, Chongqing 400010, PR China
| | - Mao Nie
- Department of Orthopaedics, The Second Affiliated Hospital of Chongqing Medical University, 76 Linjiang Road, Yuzhong District, Chongqing 400010, PR China
| | - Bai-Cheng He
- Chongqing Key Laboratory of Biochemistry and Molecular Pharmacology, Chongqing Medical University, No. 1 Yixueyuan Road, Yuzhong District, Chongqing 400010, PR China; Department of Pharmacology, School of Pharmacy, Chongqing Medical University, No. 1 Yixueyuan Road, Yuzhong District, Chongqing 400010, PR China
| | - Zhong-Liang Deng
- Department of Orthopaedics, The Second Affiliated Hospital of Chongqing Medical University, 76 Linjiang Road, Yuzhong District, Chongqing 400010, PR China.
| |
Collapse
|
23
|
Zhu B, Xue F, Zhang C, Li G. Ginkgolide B promotes osteoblast differentiation via activation of canonical Wnt signalling and alleviates osteoporosis through a bone anabolic way. J Cell Mol Med 2019; 23:5782-5793. [PMID: 31225702 PMCID: PMC6653448 DOI: 10.1111/jcmm.14503] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 05/03/2019] [Accepted: 06/03/2019] [Indexed: 12/18/2022] Open
Abstract
Osteoporosis has become a worldwide problem as the population ages. Although many advances have been made in the treatment of osteoporosis in the past few years, the outcome are sometimes disturbing because of the adverse effects of these treatments. Further studies are still needed to identify novel alternate agents to improve the therapeutic effect. Ginkgolide B (GB), a derivative of Ginkgo biloba leaves, has numerous pharmacological effects, including anticancer and anti-inflammation activities. However, the effect of GB on the regulation of osteoblast activity and bone formation effect has not yet been investigated. In this study, we showed the in vitro and in vivo effects of GB on osteoblast differentiation and bone formation. We found that GB promotes osteoblast differentiation of Bone Mesenchymal Stem Cells (BMSCs) and MC3T3-E1 cells in vitro in a Wnt/β-catenin-dependent manner. In an in vivo study, we constructed a cranial defect model in rats and treated with GB. Histomorphometric and histological analyses confirmed that the usage of GB significantly promotes bone formation. Further study on ovariectomy (OVX) rats demonstrated that GB is capable of alleviating ovariectomy-induced bone loss by enhancing osteoblast activity. Our findings indicate that GB is a potential therapeutic agent of osteoporosis through an anabolic way in bone.
Collapse
Affiliation(s)
- Bin Zhu
- Department of Orthopaedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Feng Xue
- Department of Orthopaedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Changqing Zhang
- Department of Orthopaedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Guangyi Li
- Department of Orthopaedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| |
Collapse
|
24
|
Forte L, Sarda S, Torricelli P, Combes C, Brouillet F, Marsan O, Salamanna F, Fini M, Boanini E, Bigi A. Multifunctionalization Modulates Hydroxyapatite Surface Interaction with Bisphosphonate: Antiosteoporotic and Antioxidative Stress Materials. ACS Biomater Sci Eng 2019; 5:3429-3439. [DOI: 10.1021/acsbiomaterials.9b00795] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Lucia Forte
- Department of Chemistry “G. Ciamician”, University of Bologna, via Selmi 2, 40126 Bologna, Italy
| | - Stéphanie Sarda
- CIRIMAT, Université de Toulouse, CNRS, Université Toulouse 3 - Paul Sabatier, Toulouse INP ENSIACET, 4 allée Emile Monso, 31030 Toulouse cedex 4, France
| | - Paola Torricelli
- Laboratory of Preclinical and Surgical Studies, IRCCS Rizzoli Orthopaedic Institute, via di Barbiano 1/10 40136 Bologna, Italy
| | - Christèle Combes
- CIRIMAT, Université de Toulouse, CNRS, Université Toulouse 3 - Paul Sabatier, Toulouse INP ENSIACET, 4 allée Emile Monso, 31030 Toulouse cedex 4, France
| | - Fabien Brouillet
- CIRIMAT, Université de Toulouse, CNRS, Université Toulouse 3 - Paul Sabatier, Faculté des Sciences Pharmaceutique, 35 Chemin des Maraichers, 31062 Toulouse cedex 9, France
| | - Olivier Marsan
- CIRIMAT, Université de Toulouse, CNRS, Université Toulouse 3 - Paul Sabatier, Toulouse INP ENSIACET, 4 allée Emile Monso, 31030 Toulouse cedex 4, France
| | - Francesca Salamanna
- Laboratory of Preclinical and Surgical Studies, IRCCS Rizzoli Orthopaedic Institute, via di Barbiano 1/10 40136 Bologna, Italy
| | - Milena Fini
- Laboratory of Preclinical and Surgical Studies, IRCCS Rizzoli Orthopaedic Institute, via di Barbiano 1/10 40136 Bologna, Italy
| | - Elisa Boanini
- Department of Chemistry “G. Ciamician”, University of Bologna, via Selmi 2, 40126 Bologna, Italy
| | - Adriana Bigi
- Department of Chemistry “G. Ciamician”, University of Bologna, via Selmi 2, 40126 Bologna, Italy
| |
Collapse
|
25
|
Park YC, Yoon SP, Yang KH. Localization of Atypical Femoral Fracture on Straight and Bowed Femurs. J Bone Metab 2019; 26:123-131. [PMID: 31223609 PMCID: PMC6561849 DOI: 10.11005/jbm.2019.26.2.123] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 05/08/2019] [Accepted: 05/15/2019] [Indexed: 12/15/2022] Open
Abstract
Background To elucidate the effect of anterolateral bowing on the fracture height of atypical femoral fractures (AFFs), we separated the AFFs into 2 groups according to the presence of anterolateral femoral bowing (straight group and bowing group) and analyzed the fracture height. The aims of this study were to evaluate the clinical and radiological features of AFFs in the straight group and bowing group, and to determine which factors were associated with the fracture height of AFFs in the total cohort and each subgroup. Methods Ninety-nine patients with AFFs were included in this study (43 patients in the bowing group and 56 patients in the straight group). Clinical and radiological characteristics were compared between the groups. Multivariable linear regression analysis was performed to determine the effect of factors on fracture height. Results Patients in the straight group were younger, heavier, and taller, and had a higher bone mineral density, smaller anterior and lateral bowing angles, and more proximal fracture height than those in the bowing group. Multivariable analysis showed that the presence of anterolateral bowing itself and height were associated with fracture height in the total cohort. In the subgroup analysis, the lateral bowing angle in the straight group and the estimated apex height in the bowing group were associated with fracture height. The lateral bowing angle was not significantly associated with fracture height in the total cohort and the bowing group. Conclusions The presence of anterolateral bowing and the level of the apex of the bowed femur were important factors for the fracture height of AFFs.
Collapse
Affiliation(s)
- Young-Chang Park
- Department of Orthopaedic Surgery, International St. Mary's Hospital, Catholic Kwandong University College of Medicine, Incheon, Korea
| | - Soon-Phil Yoon
- Department of Orthopaedic Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Kyu Hyun Yang
- Department of Orthopaedic Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| |
Collapse
|
26
|
Liu D, He S, Chen S, Yang L, Yang J, Bao Q, Qin H, Zhao Y, Zong Z. Different effects of Wnt/β-catenin activation and parathyroid hormone on diaphyseal and metaphyseal in the early phase of femur bone healing of mice. Clin Exp Pharmacol Physiol 2019; 46:652-663. [PMID: 30908657 PMCID: PMC6593981 DOI: 10.1111/1440-1681.13088] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 03/01/2019] [Accepted: 03/18/2019] [Indexed: 11/27/2022]
Abstract
Parathyroid hormone (PTH) and agents related to the manipulation of Wnt/β-catenin signalling are two promising anabolic anti-osteoporotic therapies that have been shown to promote the healing of bone fractures. Now, it is widely accepted that cortical bone and trabecular bone are two different compartments, and should be treated as separate compartments in pathological processes, such as fracture healing. It is currently unknown whether PTH and the activation of β-catenin signalling would demonstrate different effects on cortical bone and trabecular bone healing. In the current study, single 0.6-mm cortex holes were made in the femur metaphysis and diaphysis of mice, and then, PTH application and β-catenin activation were used to observe the promoting effect on bone healing. The effects of β-catenin and PTH signalling on fracture healing were observed by X-ray and CT at 3, 6, and 14 days after fracture, and the levels of β-catenin were detected by RT-PCR assay, and the number of specific antigen-positive cells of BRDU, OCN, RUNX2 was counted by immunohistochemical staining. While β-catenin activation and PTH were found to demonstrate similar effects on accelerating metaphyseal bone healing, activation of β-catenin showed a more striking effect than PTH on promoting diaphyseal bone healing. These findings might be helpful for selecting proper medication to accelerate fracture healing of different bone compartments.
Collapse
Affiliation(s)
- Daocheng Liu
- State Key Laboratory of Trauma, Burn and Combined injury, Department of War Wound Rescue Skills Training, Base of Army Health Service Training, Army Medical University, Chongqing, China
| | - Sihao He
- State Key Laboratory of Trauma, Burn and Combined injury, Department of War Wound Rescue Skills Training, Base of Army Health Service Training, Army Medical University, Chongqing, China
| | - Sixu Chen
- State Key Laboratory of Trauma, Burn and Combined injury, Department of War Wound Rescue Skills Training, Base of Army Health Service Training, Army Medical University, Chongqing, China
| | - Lei Yang
- State Key Laboratory of Trauma, Burn and Combined injury, Department of War Wound Rescue Skills Training, Base of Army Health Service Training, Army Medical University, Chongqing, China
| | - Jiazhi Yang
- State Key Laboratory of Trauma, Burn and Combined injury, Department of War Wound Rescue Skills Training, Base of Army Health Service Training, Army Medical University, Chongqing, China
| | - Quanwei Bao
- State Key Laboratory of Trauma, Burn and Combined injury, Department of War Wound Rescue Skills Training, Base of Army Health Service Training, Army Medical University, Chongqing, China
| | - Hao Qin
- State Key Laboratory of Trauma, Burn and Combined injury, Department of War Wound Rescue Skills Training, Base of Army Health Service Training, Army Medical University, Chongqing, China
| | - Yufeng Zhao
- State Key Laboratory of Trauma, Burn and Combined injury, Department of War Wound Rescue Skills Training, Base of Army Health Service Training, Army Medical University, Chongqing, China
| | - Zhaowen Zong
- State Key Laboratory of Trauma, Burn and Combined injury, Department of War Wound Rescue Skills Training, Base of Army Health Service Training, Army Medical University, Chongqing, China
| |
Collapse
|
27
|
Black DM, Abrahamsen B, Bouxsein ML, Einhorn T, Napoli N. Atypical Femur Fractures: Review of Epidemiology, Relationship to Bisphosphonates, Prevention, and Clinical Management. Endocr Rev 2019; 40:333-368. [PMID: 30169557 DOI: 10.1210/er.2018-00001] [Citation(s) in RCA: 115] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 05/08/2018] [Indexed: 12/18/2022]
Abstract
Bisphosphonates (BPs) are highly effective in treating osteoporosis and reducing hip, vertebral, and other fractures by as much as 50% to 70%. However, since 2006, atypical femur fractures (AFFs) emerged as potential side effects of BPs and other treatments. These fractures have unusual radiologic features and occur with little trauma. Public concern has led to a >50% decrease in BP usage. AFFs are rare: for each AFF, >1200 fractures, including 135 hip fractures, are prevented. Case definition criteria were updated by the American Society of Bone and Mineral Research in 2014. Many epidemiologic studies have been reported, and although methodologically challenging, generally support a BP-AFF association. However, the magnitude of the association between BPs and AFFs is uncertain: estimates of relative risk for AFFs among BP users vs nonusers range from 1 to 65 with a meta-analysis estimate of 1.7. Although mechanistic studies have proposed several hypotheses explaining how BPs might decrease bone strength, AFF pathogenesis remains uncertain and cannot explain the paradox of efficacy of reduction of common fractures while increasing risk for rare fractures at one site. There are several consistent risk factors, including Asian race (in North America), femoral bowing, and glucocorticoid use, whereas others remain unclear. Consensus is emerging about strategies to prevent AFFs in BP users (including drug holidays after 5 years' use in some patients). In conclusion, AFFs can be devastating, but even under the most pessimistic assumptions, the benefit/risk ratio is highly positive for BPs, particularly during 3 to 5 years of use. As understanding of AFFs increases, it is becoming increasingly possible to maximize BP benefits while minimizing AFF risk.
Collapse
Affiliation(s)
- Dennis M Black
- University of California, San Francisco, San Francisco, California
| | | | | | | | - Nicola Napoli
- Università Campus Bio-Medico di Roma, Rome, Italy.,IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| |
Collapse
|
28
|
Dolci LS, Panzavolta S, Torricelli P, Albertini B, Sicuro L, Fini M, Bigi A, Passerini N. Modulation of Alendronate release from a calcium phosphate bone cement: An in vitro osteoblast-osteoclast co-culture study. Int J Pharm 2019; 554:245-255. [DOI: 10.1016/j.ijpharm.2018.11.023] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2018] [Revised: 11/07/2018] [Accepted: 11/09/2018] [Indexed: 01/12/2023]
|
29
|
Kanis JA, Cooper C, Rizzoli R, Reginster JY. European guidance for the diagnosis and management of osteoporosis in postmenopausal women. Osteoporos Int 2019; 30:3-44. [PMID: 30324412 PMCID: PMC7026233 DOI: 10.1007/s00198-018-4704-5] [Citation(s) in RCA: 904] [Impact Index Per Article: 180.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 09/12/2018] [Indexed: 12/25/2022]
Abstract
Guidance is provided in a European setting on the assessment and treatment of postmenopausal women at risk from fractures due to osteoporosis. INTRODUCTION The International Osteoporosis Foundation and European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis published guidance for the diagnosis and management of osteoporosis in 2013. This manuscript updates these in a European setting. METHODS Systematic reviews were updated. RESULTS The following areas are reviewed: the role of bone mineral density measurement for the diagnosis of osteoporosis and assessment of fracture risk; general and pharmacological management of osteoporosis; monitoring of treatment; assessment of fracture risk; case-finding strategies; investigation of patients; health economics of treatment. The update includes new information on the evaluation of bone microstructure evaluation in facture risk assessment, the role of FRAX® and Fracture Liaison Services in secondary fracture prevention, long-term effects on fracture risk of dietary intakes, and increased fracture risk on stopping drug treatment. CONCLUSIONS A platform is provided on which specific guidelines can be developed for national use.
Collapse
Affiliation(s)
- J A Kanis
- Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Beech Hill Road, Sheffield, S10 2RX, UK.
- Mary McKillop Health Institute, Australian Catholic University, Melbourne, Australia.
| | - C Cooper
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
- NIHR Musculoskeletal Biomedical Research Unit, University of Oxford, Oxford, UK
| | - R Rizzoli
- University Hospitals and Faculty of Medicine of Geneva, Geneva, Switzerland
| | - J-Y Reginster
- Department of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium
- Prince Mutaib Chair for Biomarkers of Osteoporosis, Biochemistry Department, College of Science, King Saud University, Riyadh, Kingdom of Saudi Arabia
| |
Collapse
|
30
|
Krappinger D, Wolf B, Dammerer D, Thaler M, Schwendinger P, Lindtner RA. Risk factors for nonunion after intramedullary nailing of subtrochanteric femoral fractures. Arch Orthop Trauma Surg 2019; 139:769-777. [PMID: 30729990 PMCID: PMC6514068 DOI: 10.1007/s00402-019-03131-9] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Nonunion is a common complication after intramedullary nailing of subtrochanteric femoral fractures. A more detailed knowledge, particularly of avoidable risk factors for subtrochanteric fracture nonunion, is thus desired to develop strategies for reducing nonunion rates. The aim of the present study therefore was to analyse a wide range of parameters as potential risk factors for nonunion after intramedullary nailing of subtrochanteric fractures. MATERIALS AND METHODS Seventy-four patients who sustained a subtrochanteric fracture and were treated by femoral intramedullary nailing at a single level 1 trauma centre within a 6-year period were included in this study. A total of 15 patient-related, fracture-related, surgery-related, mechanical and biological parameters were analysed as potential risk factors for nonunion. Furthermore, the accuracy of each of these parameters to predict nonunion was calculated. RESULTS Nonunion occurred in 17 of 74 patients (23.0%). Of the 15 potential risk factors analysed, only 3 were found to have a significant effect on the nonunion rate (p < 0.05): postoperative varus malalignment, postoperative lack of medial cortical support and autodynamisation of the nail within the first 12 weeks post-surgery. Accuracy of each of these 3 parameters to predict nonunion was > 0.70. Furthermore, the nonunion rate significantly increased with the number of risk factors (no risk factor: 2.9%, one risk factor: 23.8%, two risk factors: 52.9%, and three risk factors: 100% [Chi-square test, p = 0.001)]. CONCLUSIONS Our study indicates that intraoperative correction of varus malalignment and restoration of the medial cortical support are the most critical factors to prevent nonunion after intramedullary nailing of subtrochanteric femoral fractures. In addition, autodynamisation of the nail within the first 3 months post-surgery is a strong predictor for failure and should result in revision surgery.
Collapse
Affiliation(s)
- Dietmar Krappinger
- 0000 0000 8853 2677grid.5361.1Department of Trauma Surgery, Medical University of Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria
| | - Bernhard Wolf
- 0000 0000 8853 2677grid.5361.1Department of Trauma Surgery, Medical University of Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria
| | - Dietmar Dammerer
- 0000 0000 8853 2677grid.5361.1Department of Orthopaedics, Medical University of Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria
| | - Martin Thaler
- 0000 0000 8853 2677grid.5361.1Department of Orthopaedics, Medical University of Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria
| | - Peter Schwendinger
- 0000 0000 8853 2677grid.5361.1Department of Trauma Surgery, Medical University of Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria
| | - Richard A. Lindtner
- 0000 0000 8853 2677grid.5361.1Department of Trauma Surgery, Medical University of Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria
| |
Collapse
|
31
|
Lim SJ, Yeo I, Yoon PW, Yoo JJ, Rhyu KH, Han SB, Lee WS, Song JH, Min BW, Park YS. Incidence, risk factors, and fracture healing of atypical femoral fractures: a multicenter case-control study. Osteoporos Int 2018; 29:2427-2435. [PMID: 30039251 DOI: 10.1007/s00198-018-4640-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 07/11/2018] [Indexed: 12/13/2022]
Abstract
UNLABELLED The incidence of atypical femoral fractures (AFFs) was 2.95% among 6644 hip and femoral fractures. Independent risk factors included the use of bisphosphonates (BPs), osteopenia or osteoporosis, rheumatoid arthritis, increased femoral curvatures, and thicker femoral cortices. Patients with AFFs and BP treatment were more likely to have problematic healing than those with typical femoral fractures (TFFs) and no BP treatment. INTRODUCTION To determine the incidence and risk factors of atypical femoral fractures (AFFs), we performed a multicenter case-control study. We also investigated the effects of bisphosphonates (BPs) on AFF healing. METHODS We retrospectively reviewed the medical records and radiographs of 6644 hip and femoral fractures of patients from eight tertiary referral hospitals. All the radiographs were reviewed to distinguish AFFs from TFFs. Univariate and multivariate logistic regression analyses were performed to identify risk factors, and interaction analyses were used to investigate the effects of BPs on fracture healing. RESULTS The incidence of AFFs among 6644 hip and femoral fractures was 2.95% (90 subtrochanter and 106 femoral shaft fractures). All patients were females with a mean age of 72 years, and 75.5% were exposed to BPs for an average duration of 5.2 years (range, 1-17 years). The use of BPs was significantly associated with AFFs (p < 0.001, odds ratio = 25.65; 95% confidence interval = 10.74-61.28). Other independent risk factors for AFFs included osteopenia or osteoporosis, rheumatoid arthritis, increased anterior and lateral femoral curvatures, and thicker lateral femoral cortex at the shaft level. Interaction analyses showed that patients with AFFs using BPs had a significantly higher risk of problematic fracture healing than those with TFFs and no BP treatment. CONCLUSIONS The incidence of AFFs among 6644 hip and femoral fractures was 2.95%. Osteopenia or osteoporosis, use of BPs, rheumatoid arthritis, increased anterior and lateral femoral curvatures, and thicker lateral femoral cortex were independent risk factors for the development of AFFs. Patients with AFFs and BP treatment were more likely to have problematic fracture healing than those with TFFs and no BP treatment.
Collapse
MESH Headings
- Aged
- Aged, 80 and over
- Arthritis, Rheumatoid/complications
- Arthritis, Rheumatoid/epidemiology
- Arthritis, Rheumatoid/physiopathology
- Bone Density Conservation Agents/adverse effects
- Bone Density Conservation Agents/pharmacology
- Case-Control Studies
- Diphosphonates/adverse effects
- Diphosphonates/pharmacology
- Female
- Femoral Fractures/diagnostic imaging
- Femoral Fractures/epidemiology
- Femoral Fractures/etiology
- Femoral Fractures/physiopathology
- Fracture Healing/drug effects
- Fractures, Spontaneous/diagnostic imaging
- Fractures, Spontaneous/epidemiology
- Fractures, Spontaneous/etiology
- Fractures, Spontaneous/physiopathology
- Hip Fractures/diagnostic imaging
- Hip Fractures/epidemiology
- Hip Fractures/etiology
- Hip Fractures/physiopathology
- Humans
- Incidence
- Middle Aged
- Osteoporosis, Postmenopausal/complications
- Osteoporosis, Postmenopausal/epidemiology
- Osteoporosis, Postmenopausal/physiopathology
- Osteoporotic Fractures/diagnostic imaging
- Osteoporotic Fractures/epidemiology
- Osteoporotic Fractures/etiology
- Osteoporotic Fractures/physiopathology
- Radiography
- Republic of Korea/epidemiology
- Risk Factors
Collapse
Affiliation(s)
- S-J Lim
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea
| | - I Yeo
- Department of Orthopaedic Surgery, Sejong General Hospital, Gyeongi-do, Bucheon-si, South Korea
| | - P-W Yoon
- Department Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - J J Yoo
- Department of Orthopaedic Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - K-H Rhyu
- Department of Orthopaedic Surgery, Kyung Hee Medical Center, Kyung Hee University College of Medicine, Seoul, South Korea
| | - S-B Han
- Department of Orthopedics, Korea University Anam Hospital, Korea University College of Medicine, Seongbuk-gu, Seoul, South Korea
| | - W-S Lee
- Department of Orthopaedic Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - J-H Song
- Department of Orthopaedic Surgery, St. Vincent's Hospital, The Catholic University of Korea College of Medicine, Suwon, South Korea
| | - B-W Min
- Department of Orthopaedic Surgery, Dongsan Medical Center, Kyemyung University College of Medicine, Daegu, South Korea
| | - Y-S Park
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea.
| |
Collapse
|
32
|
Abstract
Osteoporosis increases the risk of fractures, which are associated with increased mortality and lower quality of life. Patients with prevalent fracture are at high risk to of sustaining another one. Optimal protein and calcium intakes, and vitamin D supplies, together with regular weight bearing physical exercise are the corner stones of fracture prevention. Evidence for anti-fracture efficacy of pharmacological interventions relies on results from randomised controlled trials in postmenopausal women with fractures as the primary outcome. Treatments with bone resorption inhibitors, like bisphosphonates or denosumab, and bone formation stimulator like teriparatide, reduce vertebral and non-vertebral fracture risk. A reduction in vertebral fracture risk can already be detected within a year after starting therapy.
Collapse
Affiliation(s)
- René Rizzoli
- Service of Bone Diseases, Geneva University Hospitals and Faculty of Medicine, 1211 Geneva 14, Switzerland.
| |
Collapse
|
33
|
Harvey NC, McCloskey E, Kanis JA, Compston J, Cooper C. Cost-effective but clinically inappropriate: new NICE intervention thresholds in osteoporosis (Technology Appraisal 464). Osteoporos Int 2018; 29:1511-1513. [PMID: 29947864 PMCID: PMC6037288 DOI: 10.1007/s00198-018-4505-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 01/19/2018] [Indexed: 11/24/2022]
Abstract
PURPOSE To comment on the latest technology appraisal of the National Institute for Clinical Excellence (NICE) in osteoporosis. METHODS Review of NICE Technology Appraisal (TA464) on bisphosphonate use in osteoporosis. RESULTS The NICE appraisal on bisphosphonate use in osteoporosis indicates that treatment with oral bisphosphonates may be instituted at a FRAX 10-year probability of major osteoporotic fracture above 1%. Implementation would mean that all women aged 50 years or older are deemed eligible for treatment, a position that would increase the burden of rare long-term side effects across the population. CONCLUSION Cost-effectiveness thresholds for low-cost interventions should not be used to set intervention thresholds but rather to validate the implementation of clinically driven intervention thresholds.
Collapse
Affiliation(s)
- N C Harvey
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, UK
- NIHR Musculoskeletal Biomedical Research Unit, University of Oxford, Oxford, UK
| | - E McCloskey
- Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK
- Centre for Integrated Research in Musculoskeletal Ageing (CIMA), Mellanby Centre for Bone Research, University of Sheffield, Sheffield, UK
| | - J A Kanis
- Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK.
- Institute for Health and Aging, Catholic University of Australia, Melbourne, Australia.
| | - J Compston
- Cambridge Biomedical Campus, Cambridge, UK
| | - C Cooper
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, UK
- NIHR Musculoskeletal Biomedical Research Unit, University of Oxford, Oxford, UK
| |
Collapse
|
34
|
A new multifunctionalized material against multi-drug resistant bacteria and abnormal osteoclast activity. Eur J Pharm Biopharm 2018; 127:120-129. [DOI: 10.1016/j.ejpb.2018.02.018] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Revised: 02/02/2018] [Accepted: 02/14/2018] [Indexed: 11/19/2022]
|
35
|
Xu CY, Zhao S, Wang YY, Sha H, Sun JN, Jin FY, Niu F. Curative Effects of Zoledronic Acid Combined with Calcitonin on the Treatment of Bone Metastasis and Osteoporosis in Lung Cancer. INT J PHARMACOL 2018. [DOI: 10.3923/ijp.2018.471.476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
36
|
Simm PJ, Biggin A, Zacharin MR, Rodda CP, Tham E, Siafarikas A, Jefferies C, Hofman PL, Jensen DE, Woodhead H, Brown J, Wheeler BJ, Brookes D, Lafferty A, Munns CF. Consensus guidelines on the use of bisphosphonate therapy in children and adolescents. J Paediatr Child Health 2018; 54:223-233. [PMID: 29504223 DOI: 10.1111/jpc.13768] [Citation(s) in RCA: 77] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 07/28/2017] [Accepted: 08/17/2017] [Indexed: 12/21/2022]
Abstract
Bisphosphonate therapy is the mainstay of pharmacological intervention in young people with skeletal fragility. The evidence of its use in a variety of conditions remains limited despite over three decades of clinical experience. On behalf of the Australasian Paediatric Endocrine Group, this evidence-based consensus guideline presents recommendations and discusses the graded evidence (using the GRADE system) for these recommendations. Primary bone fragility disorders such as osteogenesis imperfecta are considered separately from osteoporosis secondary to other clinical conditions (such as cerebral palsy, Duchenne muscular dystrophy). The use of bisphosphonates in non-fragility conditions, such as fibrous dysplasia, avascular necrosis, bone cysts and hypercalcaemia, is also discussed. While these guidelines provide an evidence-based approach where possible, further research is required in all clinical applications in order to strengthen the recommendations made.
Collapse
Affiliation(s)
- Peter J Simm
- Department of Endocrinology and Diabetes, Royal Children's Hospital, Melbourne, Victoria, Australia.,Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Andrew Biggin
- Institute of Endocrinology and Diabetes, Children's Hospital at Westmead, Sydney, New South Wales, Australia.,Discipline of Child and Adolescent Health, University of Sydney, Sydney, New South Wales, Australia
| | - Margaret R Zacharin
- Department of Endocrinology and Diabetes, Royal Children's Hospital, Melbourne, Victoria, Australia.,Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Christine P Rodda
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Australian Institute for Musculoskeletal Research, Sunshine Hospital, Melbourne, Victoria, Australia.,Department of Paediatrics, Sunshine Hospital, Melbourne, Victoria, Australia
| | - Elaine Tham
- Department of Endocrinology and Diabetes, Women's and Children's Hospital, Adelaide, South Australia, Australia
| | - Aris Siafarikas
- Department of Endocrinology and Diabetes, Princess Margaret Hospital, Perth, Western Australia, Australia.,School of Paediatrics and Child Health, University of Western Australia, Perth, Western Australia, Australia.,Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia.,Institute for Health Research, University of Notre Dame, Fremantle, Western Australia, Australia
| | - Craig Jefferies
- Department of Endocrinology and Diabetes, Starship Children's Health, Auckland, New Zealand
| | - Paul L Hofman
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Diane E Jensen
- Children's Health Queensland, Hospital and Health Services District, South Brisbane, Queensland, Australia.,Centre for Children's Health Research, University of Queensland, Brisbane, Queensland, Australia
| | - Helen Woodhead
- Department of Endocrinology and Diabetes, Sydney Children's Hospital, Sydney, New South Wales, Australia.,Department of Endocrinology and Diabetes, Royal North Shore Hospital, Sydney, New South Wales, Australia.,School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Justin Brown
- Department of Paediatric Endocrinology, Monash Children's Hospital, Melbourne, Victoria, Australia.,Department of Paediatrics, Monash University, Melbourne, Victoria, Australia
| | - Benjamin J Wheeler
- Women's and Children's Health, University of Otago, Dunedin, New Zealand
| | - Denise Brookes
- Centre for Children's Health Research, University of Queensland, Brisbane, Queensland, Australia
| | - Antony Lafferty
- Department of Paediatrics, Canberra Hospital, Canberra, Australian Capital Territory, Australia.,Department of Paediatrics and Child Health, Australian National University Medical School, Canberra, Australian Capital Territory, Australia
| | - Craig F Munns
- Institute of Endocrinology and Diabetes, Children's Hospital at Westmead, Sydney, New South Wales, Australia.,Discipline of Child and Adolescent Health, University of Sydney, Sydney, New South Wales, Australia
| | | |
Collapse
|
37
|
Abstract
Atypical Femoral Fractures (AFF) represent fractures located between the lesser trochanter and the supracondylar flare of a femur. An increasing pool of evidence supports their association with the prolonged use of bisphosphonates, even though a direct correlation is yet to be proved. The purpose of this review is to encapsulate the current evidence associating bisphosphonate use and the development of AFFs, the clinical features related to their presentation, as well as to report the armamentarium of strategies available in the prevention and treatment of AFFs. Based on these evidence, we propose a management algorithm for AFFs, that can serve as a guide for patients presenting with this condition.
Collapse
|
38
|
Lee YK, Kim HS, Cho HS, Koo KH. Subtrochanteric femoral stress fracture with features of atypical femoral fracture in patient with Paget's disease: a case report. ACTA ACUST UNITED AC 2018; 14:368-371. [PMID: 29354170 DOI: 10.11138/ccmbm/2017.14.3.368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Atypical femoral fracture (AFF) has been widely issued since the American Society for Bone and Mineral Research (ASBMR) taskforce stated a possible association with long-term use of bisphosphonate in 2010. ASBMR taskforce recommended to include Paget's disease as one of variables to investigate the AFF in 2010. On the other hand, the ASBMR taskforce in 2014 excluded Paget's disease in the definition of AFF. Still, any rationale has been barely documented about this change. We described the rationale by reporting an 85-year-old man who had a subtrochanteric fracture with features of atypical femoral fracture which turned out to be Paget's disease of bone in the pathology.
Collapse
Affiliation(s)
- Young-Kyun Lee
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hong Seok Kim
- Department of Orthopaedic Surgery, Seoul National University Hospital, Seoul, Korea
| | - Hwan Seong Cho
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Kyung-Hoi Koo
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| |
Collapse
|
39
|
Bigi A, Boanini E. Calcium Phosphates as Delivery Systems for Bisphosphonates. J Funct Biomater 2018; 9:E6. [PMID: 29342839 PMCID: PMC5872092 DOI: 10.3390/jfb9010006] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 01/08/2018] [Accepted: 01/11/2018] [Indexed: 12/16/2022] Open
Abstract
Bisphosphonates (BPs) are the most utilized drugs for the treatment of osteoporosis, and are usefully employed also for other pathologies characterized by abnormally high bone resorption, including bone metastases. Due to the great affinity of these drugs for calcium ions, calcium phosphates are ideal delivery systems for local administration of BPs to bone, which is aimed to avoid/limit the undesirable side effects of their prolonged systemic use. Direct synthesis in aqueous medium and chemisorptions from solution are the two main routes proposed to synthesize BP functionalized calcium phosphates. The present review overviews the information acquired through the studies on the interaction between bisphosphonate molecules and calcium phosphates. Moreover, particular attention is addressed to some important recent achievements on the applications of BP functionalized calcium phosphates as biomaterials for bone substitution/repair.
Collapse
Affiliation(s)
- Adriana Bigi
- Department of Chemistry "G. Ciamician", University of Bologna, 40126 Bologna, Italy.
| | - Elisa Boanini
- Department of Chemistry "G. Ciamician", University of Bologna, 40126 Bologna, Italy.
| |
Collapse
|
40
|
Forte L, Sarda S, Combes C, Brouillet F, Gazzano M, Marsan O, Boanini E, Bigi A. Hydroxyapatite functionalization to trigger adsorption and release of risedronate. Colloids Surf B Biointerfaces 2017; 160:493-499. [DOI: 10.1016/j.colsurfb.2017.09.055] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 09/07/2017] [Accepted: 09/27/2017] [Indexed: 12/11/2022]
|
41
|
Sànchez-Riera L, Wilson N. Fragility Fractures & Their Impact on Older People. Best Pract Res Clin Rheumatol 2017; 31:169-191. [PMID: 29224695 DOI: 10.1016/j.berh.2017.10.001] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 08/05/2017] [Accepted: 09/14/2017] [Indexed: 01/31/2023]
Abstract
Osteoporotic fractures, in particular hip and vertebral, are a major health burden worldwide. The majority of these fractures occur in the elderly population, resulting in one of the most important causes of mortality and disability in older ages. Their cost for societies is enormous and is forecast to steadily increase over the coming decades globally. Low bone mineral density (BMD) remains a key preventable risk factor for fractures. Screening and treatment of individuals with high risk of fracture is cost-effective. Predictive tools including clinical risk factors, minimisation of falls risk and public authorities' support to create Fracture Liaison Services are paramount strategies.
Collapse
Affiliation(s)
- Lídia Sànchez-Riera
- University Hospital Bristol NHS Foundation Trust, Bristol, UK; Institute of Bone and Joint Research, The Kolling Institute, Sydney Medical School, St Leonards, NSW, Australia.
| | - Nicholas Wilson
- Institute of Bone and Joint Research, The Kolling Institute, Sydney Medical School, St Leonards, NSW, Australia
| |
Collapse
|
42
|
Harvey NC, McCloskey E, Kanis JA, Compston J, Cooper C. Bisphosphonates in osteoporosis: NICE and easy? Lancet 2017; 390:2243-2244. [PMID: 29165263 PMCID: PMC5724749 DOI: 10.1016/s0140-6736(17)32850-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 10/06/2017] [Indexed: 01/16/2023]
Affiliation(s)
- Nicholas C Harvey
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton, SO16 6YD, UK; National Institute for Health Research (NIHR) Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton National Health Service Foundation Trust, Southampton, UK
| | - Eugene McCloskey
- Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK; Centre for Integrated Research in Musculoskeletal Ageing, Mellanby Centre for Bone Research, University of Sheffield, Sheffield, UK
| | - John A Kanis
- Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK; Institute for Health and Aging, Catholic University of Australia, Melbourne, VIC, Australia
| | | | - Cyrus Cooper
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton, SO16 6YD, UK; National Institute for Health Research (NIHR) Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton National Health Service Foundation Trust, Southampton, UK; NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK.
| |
Collapse
|
43
|
Lee YK, Kim TY, Ha YC, Song SH, Kim JW, Shon HC, Chang JS, Koo KH. Atypical subtrochanteric fractures in Korean hip fracture study. Osteoporos Int 2017; 28:2853-2858. [PMID: 28612307 DOI: 10.1007/s00198-017-4112-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2017] [Accepted: 06/04/2017] [Indexed: 12/18/2022]
Abstract
UNLABELLED In Korean, atypical subtrochanteric fractures (ASF) were rare. Higher BMI and use of bisphosphonate were significant risk factors of ASF. INTRODUCTION Recently, ASF have been reported to increase among patients on bisphosphonate. However, the incidence of ASF and the association between ASF and bisphosphonate use have not been well defined in Asian population. Our purposes are (1) to estimate the proportion of ASF among Korean patients with proximal femur fracture and (2) to determine the associated risk factors of ASF in the Korean patients. METHODS We conducted a multicenter (16 academic hospitals), prospective Korean hip fracture study on hip fracture in a cohort of patients aged 50 years or older from South Korea between July 2014 and May 2016. As a part of Korean hip fracture study, primary analysis examined the proportion of ASF among proximal femur fracture. To identify ASF, according to the definition by ASBMR task force, all radiographs of subtrochanteric fracture were reviewed. Associated risk factors for occurrence of ASF were also evaluated by using multivariable logistic regression analysis. RESULTS Among 1361 patients with proximal femoral fractures due to low-energy trauma, 17 fractures (1.2%) were identified as ASF. Higher BMI and use of bisphosphonate before injury were independent risk factors of ASF. CONCLUSION In Korean, ASF were rare. Higher BMI and use of bisphosphonate were significant risk factors of ASF.
Collapse
Affiliation(s)
- Y-K Lee
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - T-Y Kim
- Department of Orthopaedic Surgery, Hallym University Sacred Heart Hospital, Anyang, South Korea
| | - Y-C Ha
- Department of Orthopaedic Surgery, College of Medicine, Chung-Ang University, 224-1 Heukseok-dong, Dongjak-gu, Seoul, 156-755, South Korea.
| | - S-H Song
- Department of Orthopaedic Surgery, Myongji Hospital, Goyang, South Korea
| | - J W Kim
- Department of Orthopedic Surgery, Haeundae Paik Hospital, College of Medicine, Inje University, Busan, South Korea
| | - H C Shon
- Department of Orthopaedic Surgery, College of Medicine, Chungbuk National University, Cheongju, South Korea
| | - J S Chang
- Department of Orthopedic Surgery, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, South Korea
| | - K-H Koo
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| |
Collapse
|
44
|
Forte L, Torricelli P, Boanini E, Gazzano M, Fini M, Bigi A. Antiresorptive and anti-angiogenetic octacalcium phosphate functionalized with bisphosphonates: An in vitro tri-culture study. Acta Biomater 2017; 54:419-428. [PMID: 28238916 DOI: 10.1016/j.actbio.2017.02.040] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Revised: 02/16/2017] [Accepted: 02/22/2017] [Indexed: 01/05/2023]
Abstract
Development of new materials for the local administration of bisphosphonates (BPs) is aimed to avoid the negative side effects of prolonged systemic use of these potent drugs. In this work, we synthesized octacalcium phosphate (OCP) in the presence of two potent BPs and obtained a single crystalline phase up to a zoledronate and alendronate content of 3.5wt% and 5.2wt%, respectively. Both BPs provoke minor structural modifications and a reduction of the crystal dimensions of OCP, which suggests a preferential interaction of the BPs with the structure of the calcium phosphate. Alendronate containing samples display increased values of zeta potential with respect to that of OCP, and an initial burst release of the BP in solution. At variance, the zeta potential of zoledronate functionalized samples decreases on increasing the content of zoledronate, which is not appreciably released in solution. Bone microenvironment response to the composite materials was investigated in vitro using a triculture model. BP functionalized samples downregulate the viability of the cells, sustain osteoblast differentiation and accelerate the production of collagen type I and osteocalcin. At variance, they inhibit monocyte differentiation into osteoclast and provoke a dose dependent reduction of VEGF production, exhibiting antiresorptive and anti-angiogenetic properties that can be usefully exploited for the local treatment of abnormal bone losses. STATEMENT OF SIGNIFICANCE Bisphosphonates (BPs) are powerful drugs for the treatment of bone diseases. However, BPs systemic administration suffers several undesirable side effects, which stimulate the development of suitable systems for their local administration. In this study we functionalized octacalcium phosphate (OCP) with alendronate and zoledronate in order to get biomaterials able to couple the good biological performance of OCP with the therapeutic properties of the BPs. The results provide novel information on the interaction between these two potent BPs and octacalcium phosphate. Moreover, the triculture in vitro study indicates that the synthesized composite materials stimulate the production of bone extracellular matrix, inhibit monocytes differentiation into osteoclasts and downregulate the release of Vascular Endothelial Growth Factor (VEGF) in a dose dependent way. The data allow to state that the new composite materials can be usefully employed for the local treatment of diseases involving abnormally high bone resorption.
Collapse
Affiliation(s)
- Lucia Forte
- Department of Chemistry "G. Ciamician", University of Bologna, via Selmi 2, 40126 Bologna, Italy
| | - Paola Torricelli
- Laboratory of Preclinical and Surgical Studies, Research Institute Codivilla Putti - Rizzoli Orthopaedic Institute, via di Barbiano 1/10, 40136 Bologna, Italy
| | - Elisa Boanini
- Department of Chemistry "G. Ciamician", University of Bologna, via Selmi 2, 40126 Bologna, Italy.
| | - Massimo Gazzano
- ISOF-CNR, c/o Department of Chemistry "G. Ciamician", Bologna, Italy
| | - Milena Fini
- Laboratory of Preclinical and Surgical Studies, Research Institute Codivilla Putti - Rizzoli Orthopaedic Institute, via di Barbiano 1/10, 40136 Bologna, Italy
| | - Adriana Bigi
- Department of Chemistry "G. Ciamician", University of Bologna, via Selmi 2, 40126 Bologna, Italy
| |
Collapse
|
45
|
Anagnostis P, Paschou SA, Mintziori G, Ceausu I, Depypere H, Lambrinoudaki I, Mueck A, Pérez-López FR, Rees M, Senturk LM, Simoncini T, Stevenson JC, Stute P, Trémollieres FA, Goulis DG. Drug holidays from bisphosphonates and denosumab in postmenopausal osteoporosis: EMAS position statement. Maturitas 2017; 101:23-30. [PMID: 28539165 DOI: 10.1016/j.maturitas.2017.04.008] [Citation(s) in RCA: 73] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Bisphosphonates and denosumab are used extensively in the treatment of postmenopausal osteoporosis. Despite their proven efficacy in the reduction of vertebral and non-vertebral fractures, their optimal duration of use has not been determined. The occurrence of adverse effects, such as osteonecrosis of the jaw (ONJ) and atypical femoral fractures (AFF), has raised the issue of bisphosphonate or denosumab discontinuation ("drug holiday") after a certain treatment period. AIM To assess the effect of bisphosphonate and denosumab discontinuation on fracture risk, as well as its possible benefits in reducing the risk of adverse effects. METHODS Systematic review and consensus of expert opinion. RESULTS AND CONCLUSIONS Discontinuation of bisphosphonates should be considered in all patients who have beentreated for more than five years with alendronate, risedronate or zoledronic acid. In view of the limited evidence, no robust recommendations can be made for ibandronate and denosumab. If the patient has not experienced fractures before or during therapy and the fracture risk is low, a "drug holiday" canbe recommended. Although there is no solid evidence, 1-2 years for risedronate, 3-5 years for alendronate and 3-6 years for zoledronic acid are suggested. After this time, the patient should be reassessed. If a new fracture is experienced, or fracture risk has increased or BMD remains low (femoral neck T-score ≤-2.5), anti-osteoporotic treatment should be resumed. In the case of denosumab discontinuation, close monitoring is suggested, due to the possibility of rebound fractures.
Collapse
Affiliation(s)
- Panagiotis Anagnostis
- Unit of Reproductive Endocrinology, First Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Greece.
| | - Stavroula A Paschou
- Unit of Reproductive Endocrinology, First Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Greece
| | - Gesthimani Mintziori
- Unit of Reproductive Endocrinology, First Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Greece
| | - Iuliana Ceausu
- Department of Obstetrics and Gynecology, 'Carol Davila' University of Medicine and Pharmacy, and Department of Obstetrics and Gynecology, 'Dr. I. Cantacuzino' Hospital, Bucharest, Romania
| | - Herman Depypere
- Breast Clinic and Menopause Clinic, University Hospital, De Pintelaan 185, 9000 Gent, Belgium
| | - Irene Lambrinoudaki
- Second Department of Obstetrics and Gynecology, National and Kapodestrian University of Athens, Greece
| | - Alfred Mueck
- University Women's Hospital of Tuebingen,Calwer Street 7, 72076 Tuebingen, Germany
| | - Faustino R Pérez-López
- Department of Obstetrics and Gynecology, Zaragoza University Faculty of Medicine, Lozano-Blesa University Hospital, Zaragoza 50009, Spain
| | - Margaret Rees
- Women's Centre, John Radcliffe Hospital, Oxford OX3 9DU, UK
| | - Levent M Senturk
- Istanbul University Cerrahpasa School of Medicine, Dept. of Obstetrics and Gynecology, Division of Reproductive Endocrinology, IVF Unit, Istanbul, Turkey
| | - Tommaso Simoncini
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma, 67, 56100, Pisa, Italy
| | - John C Stevenson
- National Heart and Lung Institute, Imperial College London, Royal Brompton Hospital, London SW3 6NP, UK
| | - Petra Stute
- Department of Obstetrics and Gynecology, University Women's Hospital, Bern, Switzerland
| | - Florence A Trémollieres
- Menopause and Metabolic Bone Disease Unit, Hôpital Paule de Viguier, CHU Toulouse, Toulouse, France
| | - Dimitrios G Goulis
- Unit of Reproductive Endocrinology, First Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Greece
| |
Collapse
|
46
|
Yang SP, Kim TWB, Boland PJ, Farooki A. Retrospective Review of Atypical Femoral Fracture in Metastatic Bone Disease Patients Receiving Denosumab Therapy. Oncologist 2017; 22:438-444. [PMID: 28275116 DOI: 10.1634/theoncologist.2016-0192] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 12/02/2016] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Denosumab therapy is used to reduce skeletal-related events in metastatic bone disease (MBD). There have been reports of atypical femoral fracture (AFF) in osteoporotic patients treated with denosumab but none in the context of higher dose and more frequent denosumab therapy for MBD. The goal of this study was to assess the incidence of AFF in MBD. PATIENTS AND METHODS We conducted a retrospective review of 253 patients who received a minimum of 12 doses of denosumab at 120 mg each for MBD. To identify patients with asymptomatic atypical stress reactions in the lateral subtrochanteric femur (which precede fractures), we reviewed the skeletal images of 66 patients who had received at least 21 doses of denosumab for AFF features. RESULTS These patients received a median of 17 doses, with a median treatment duration of 23 months. There was 1 case of undiagnosed clinical AFF detected after chart review and 2 cases of subclinical atypical femoral stress reaction observed on imaging review after 23 doses of denosumab over 33 months, 28 doses over 27 months, and 21 doses over 21 months, respectively. Scout computed tomography films showed diffuse cortical thickening of diaphysis with localized periosteal reaction of lateral femoral cortex. Bone scan and magnetic resonance imaging scan of 2 patients with stress reactions confirmed the diagnosis. CONCLUSION The incidence of clinical AFF in this context is 0.4% (1/253; 95% confidence interval [CI] 0.1%-2.2%), and the incidence of atypical femoral stress reaction based on imaging review is 4.5% (3/66; 95% CI 1.6%-12.5%). Clinicians should be aware of the clinical prodrome (which may or may not be present) and antecedent imaging changes associated with AFF. The Oncologist 2017;22:438-444Implications for Practice: Among patients with metastatic bone disease treated with denosumab, cases of clinical and subclinical atypical femoral fracture (AFF) are rare. The one detected case of clinical fracture went unrecognized despite prodromic symptoms. Clinicians should be aware of (a) the potential prodrome of anterior thigh/groin pain and (b) subclinical imaging changes in the lateral femur, both of which may precede clinical AFF.
Collapse
Affiliation(s)
- Samantha Peiling Yang
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Endocrinology Division, Department of Medicine, National University Hospital, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Tae Won B Kim
- Department of Orthopedic Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Orthopedic Oncology Division, Department of Orthopedic Surgery, Cooper University Hospital, Camden, New Jersey, USA
| | - Patrick J Boland
- Department of Orthopedic Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Azeez Farooki
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Weill Cornell Medical College, New York, New York, USA
| |
Collapse
|
47
|
Montesi M, Panseri S, Dapporto M, Tampieri A, Sprio S. Sr-substituted bone cements direct mesenchymal stem cells, osteoblasts and osteoclasts fate. PLoS One 2017; 12:e0172100. [PMID: 28196118 PMCID: PMC5308610 DOI: 10.1371/journal.pone.0172100] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Accepted: 01/31/2017] [Indexed: 12/14/2022] Open
Abstract
Strontium-substituted apatitic bone cements enriched with sodium alginate were developed as a potential modulator of bone cells fate. The biological impact of the bone cement were investigated in vitro through the study of the effect of the nanostructured apatitic composition and the doping of strontium on mesenchymal stem cells, pre-osteoblasts and osteoclasts behaviours. Up to 14 days of culture the bone cells viability, proliferation, morphology and gene expression profiles were evaluated. The results showed that different concentrations of strontium were able to evoke a cell-specific response, in fact an inductive effect on mesenchymal stem cells differentiation and pre-osteoblasts proliferation and an inhibitory effect on osteoclasts activity were observed. Moreover, the apatitic structure of the cements provided a biomimetic environment suitable for bone cells growth. Therefore, the combination of biological features of this bone cement makes it as promising biomaterials for tissue regeneration.
Collapse
Affiliation(s)
- Monica Montesi
- Institute of Science and Technology for Ceramics, National Research Council, Faenza, Ravenna, Italy
| | - Silvia Panseri
- Institute of Science and Technology for Ceramics, National Research Council, Faenza, Ravenna, Italy
| | - Massimiliano Dapporto
- Institute of Science and Technology for Ceramics, National Research Council, Faenza, Ravenna, Italy
| | - Anna Tampieri
- Institute of Science and Technology for Ceramics, National Research Council, Faenza, Ravenna, Italy
| | - Simone Sprio
- Institute of Science and Technology for Ceramics, National Research Council, Faenza, Ravenna, Italy
| |
Collapse
|
48
|
Uppin R, Gupta S, Prakash S. A Case Report of Bisphosphonate-induced Bilateral Osteoporotic Subtrochanteric Fracture Femurii: Review of Literature. J Orthop Case Rep 2017; 6:31-34. [PMID: 28164049 PMCID: PMC5288620 DOI: 10.13107/jocr.2250-0685.558] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Osteoporosis is a significant health-care problem characterized by excessive skeletal fragility, susceptibility to low-trauma fractures in men as well as women. Any abnormality of the bone that reduces the strength of the bone predisposes it to mechanical failure during normal activity or with minimum trauma. The mechanical failure manifests itself as a fracture, and this fracture must be recognized as a pathological fracture if the patient is to be treated properly. Osteoporosis is one of the leading causes of such pathological fractures and accounts for 1.5 million fractures annually. In the following case report, we present a 56-year-old postmenopausal female patient with bilateral pathological subtrochanteric fracture femurii due to intake of bisphosponates for 4 years for osteoporosis. Bilateral pathological subtrochanteric femurii fractures are extremely uncommon injuries which occur in adults who sustain injuries due to trivial trauma. A variety of management modalities has been tried to treat this complex fracture pattern. Standard fixation treatment is intramedullary nailing. CASE REPORT A postmenopausal female of rheumatoid arthritis aged 56 years, presented to our emergency department with a history of trivial fall at home. Following the fall, she was unable to bear weight on bilateral feet and complained of deformity. History revealed consumption of bisphosphonates (tablet alendronate 10 mg) for the last 4 years and glucocorticoids for rheumatiod arthritis. Radiographs were taken, which revealed bilateral pathological subtrochanteric fracture femurii. After obtaining necessary fitness, the patient was taken up for surgery. Closed reduction and Internal fixation with long proximal femoral nail were done. Bisphosphonate intake was stopped and teriparatide 20 µg/day subcutaneously given for 3 months. Fracture healed after 3 months and patient resumed her daily activities. CONCLUSION In people taking long-term bisphoshponate therapy, symptomatic cortical stress reactions accompanied by evidence of a stress line across the cortical thickening suggest an increased risk of a complete stress fracture. The patients should be informed about the prodromal symptoms like pain and swelling, following this bisphosphonates should be stopped and teriparatide has to be started for osteoporosis.
Collapse
Affiliation(s)
- Rajendra Uppin
- Department of Orthopaedics, J.N. Medical College, KLE University, Belgaum, Karnataka, India
| | - Srinath Gupta
- Department of Orthopaedics, J.N. Medical College, KLE University, Belgaum, Karnataka, India
| | - Shivank Prakash
- Department of Orthopaedics, J.N. Medical College, KLE University, Belgaum, Karnataka, India
| |
Collapse
|
49
|
Szolomayer LK, Ibe IK, Lindskog DM. Bilateral atypical femur fractures without bisphosphonate exposure. Skeletal Radiol 2017; 46:241-247. [PMID: 27900455 DOI: 10.1007/s00256-016-2526-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Revised: 10/24/2016] [Accepted: 10/27/2016] [Indexed: 02/02/2023]
Abstract
Atypical femur fractures have common radiographic features that set them apart from more typical higher-energy subtrochanteric femur fractures. They are noncomminuted, transverse fractures with medial spiking of the femoral cortex and increased lateral cortical thickness. These fractures have been associated in the literature with the use of bisphosphonate medications. This case describes bilateral atypical femur fractures in a patient with a medical history devoid of bisphosphonate use. We present his history, co-morbidities, and subsequent treatment. From this case, we call attention to bisphosphonate use as not the only cause of subtrochanteric femur fractures with atypical features and highlight that some patients may sustain these injuries even bilaterally without use of the medications. In addition, it is important to identify this fracture type and obtain imaging of the contralateral femur to facilitate prophylactic treatment if needed.
Collapse
Affiliation(s)
- Lauren K Szolomayer
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, 800 Howard Avenue, Suite 1st Floor, New Haven, CT, 06510, USA.
| | - Izuchukwu K Ibe
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, 800 Howard Avenue, Suite 1st Floor, New Haven, CT, 06510, USA
| | - Dieter M Lindskog
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, 800 Howard Avenue, Suite 1st Floor, New Haven, CT, 06510, USA
| |
Collapse
|
50
|
Eisenstein N, Kasavkar G, Bhavsar D, Khan FS, Paskins Z. Incidence and medical management of bisphosphonate-associated atypical femoral fractures in a major trauma centre: a retrospective observational study. BMC Musculoskelet Disord 2017; 18:29. [PMID: 28114975 PMCID: PMC5259836 DOI: 10.1186/s12891-017-1392-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Accepted: 01/11/2017] [Indexed: 12/30/2022] Open
Abstract
Background Atypical femoral fractures (AFFs) are rare events associated with increased duration of bisphosphonate exposure. Recommended management of AFFs include cessation of bisphosphonates and imaging of the contralateral femur. The aims of this study were to identify the local incidence of AFFs in bisphosphonate users and to audit the medical management of AFFs against published recommendations. Methods A retrospective analysis of the admissions database for a major trauma centre identified all femoral fractures (3150) in a five-year period (July 2009 to June 2014). Electronic health records and radiographs were reviewed using the 2013 American Society for Bone and Mineral Research (ASBMR) diagnostic criteria for AFF to establish the number of cases. To estimate incidence, the total number of bisphosphonate users was derived from primary care prescription and secondary care day-case records. Medical management of cases with AFF on bisphosphonates was audited against guidance from ASBMR and Medicines & Healthcare Products Regulatory Agency. Results 10 out of 3150 femoral fractures met criteria for AFF; 7 of these patients had a history of exposure to bisphosphonates (6 oral, 1 intravenous). There were 19.1 AFFs per 100,000 years of bisphosphonate use in our region. Bisphosphonates were stopped and the contralateral femur imaged in only 2 of the 7 patients treated with bisphosphonates. Conclusion Our local incidence is in line with published figures; however, this is the first published evidence suggesting that medical management and identification of AFF may be suboptimal. Managing these patients remains challenging due to their rarity and possible lack of awareness.
Collapse
Affiliation(s)
- Neil Eisenstein
- Royal Centre for Defence Medicine, Birmingham, UK.,Department of Trauma and Orthopaedics, Royal Stoke University Hospital, Stoke-On-Trent, UK.,School of Chemical Engineering, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Ganesh Kasavkar
- Department of Rheumatology, Haywood Hospital, Stoke-On-Trent, UK
| | - Dhruva Bhavsar
- Department of Trauma and Orthopaedics, Royal Stoke University Hospital, Stoke-On-Trent, UK
| | - Faisal Shehzaad Khan
- Department of Trauma and Orthopaedics, Royal Stoke University Hospital, Stoke-On-Trent, UK
| | - Zoe Paskins
- Department of Rheumatology, Haywood Hospital, Stoke-On-Trent, UK. .,Research Institute for Primary Care & Health Sciences, Keele University, Keele, ST5 5BG, UK.
| |
Collapse
|