Surgical outcome of atypical subtrochanteric and femoral fracture related to bisphosphonates use in osteoporotic patients with or without teriparatide treatment

BMC Musculoskeletal Disorders

Research Article

Chien-Hao Chen¹  Tung-Yi Lin¹  Chia-Wei Chang¹  Tsai-Sheng Fu¹  Lih-Huei Chen²  Wen-Ling Yeh³  Chun-Yi Su³ 

[1] Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Keelung branch, Bone and Joint Research Center, and Chang Gung University,, F7, No 222 Mai-King Road, Keelung, Taiwan, Taiwan;Department of Orthopedic Surgery, Division of Trauma, Chang Gung Memorial Hospital, Linkou branch, Bone and Joint Research Center and Chang Gung University, Taoyuan, Taiwan;null;

关键词: Atypical femur fractures;    Bisphosphonates;    Osteoporosis;    Teriparatide;   

DOI  :  10.1186/s12891-017-1878-5

 received in 2017-07-10, accepted in 2017-11-28,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundAtypical subtrochanteric fracture and femoral fracture have been considered to be rare complications related to long-term bisphosphonates use. A reduced bone turnover rate may lead to delayed bone healing. Limited data have revealed that teriparatide treatment may reverse the effect of bisphosphonates and be effective in bone healing.MethodsWe reviewed patients with atypical subtrochanteric and femoral fracture related to bisphosphonates use between January 2008 and December 2014. Thirteen female patients were enrolled. Radiographic findings were compatible with the characteristics of atypical fracture. Surgical intervention was performed for all, and teriparatide use was advised postoperatively. Outcome measures included perioperative results, and clinical and radiographic outcome.ResultsOf the 13 female patients enrolled, 10 had subtrochanteric and 6 had proximal femoral fracture; 3 had bilateral fractures. The mean age of the patients at surgery was 70.15±6.36 years. Most fractures (68.8%) presented prodromal thigh pain. All patients were treated with an intramedullary fixation system without severe complications. The patients were divided into 2 groups based on whether they had received treatment with teriparatide or not. The mean time to bone union was 4.4 months in the teriparatide-treated group, and 6.2 months in the non-teriparatide-treated group (p=0.116). Six patients (75%) in the teriparatide-treated group and 4 (50%) in the non-teriparatide-treated group (p= 0.3) achieved bone union within 6 months. The means of the modified Harris Hip Score and Numerical Rating Scale were significantly better in the teriparatide-treated group at postoperative 6 months. Seven patients had the same ability to walk at the 1-year follow-up as they did before the atypical fracture.ConclusionsTeriparatide treatment in patients with atypical fracture may help in fracture healing, hip function recovery, and pain relief in this reduced bone turnover patient group.

【 授权许可】

CC BY   
© The Author(s). 2017