Bisphosphonate therapy associated with Atypical periprosthet
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Atypical femoral fracture is one of the many complications after the long-term use of bisphosphonates. The American Society for Bone and Mineral Research has officially excluded periprosthetic femoral fractures (PFFs) from the definition of atypical femoral fractures (AFFs). Several case reports found that PFFs can occur with characteristics similar to those of AFFs. The purpose of our study was to evaluate the proportion of atypical fractures among Vancouver type B1 fractures, and to determine the association between the long-term use of bisphosphonates and the occurrence of atypical periprosthetic femoral fractures (APFFs).

In a retrospective study, researchers reviewed 41 patients with Vancouver type B1 periprosthetic fractures and classified them into two groups, namely atypical and typical PFFs, based on the fracture morphology. they noted the proportion of atypical periprosthetic fractures among B1 fractures and identified risk factors. Among the 41 PFFs, 5 (13%) fractures were classified as atypical PFF based on the radiological characteristics. The longer duration of bisphosphonate use was probably the only independent risk factor that significantly increases the occurrence of APFF. There were no significant differences in comorbidities, corticosteroid use, positioning of the femoral stem, the method of fixation (cemented or cementless) and time lapse from before the primary prosthesis implantation to the PFF in the development of atypical fracture type.

On the basis of results and the literature it appears that atypical femoral fractures can occur in the periprosthetic form and display a significant correlation with bisphosphonate use. The medical management of atypical fractures is a big challenge and the outcome is much poorer than that of the typical fractures because of the delayed healing process, poor bone consolidation, difficulty of fracture fixation and high mortality rate. Nevertheless, results indicate that clinicians should consider the possibility of atypical fracture, when periprosthetic Vancouver type B1 fracture occurred if long-term bisphosphonate therapy is mentioned in the patient history. Bisphosphonate therapy should be applied carefully, always bearing in mind the risk-benefit ratio. Keeping up to date with the latest antiresorptive medications and follow up-care of patients is crucial for correct patient treatment.

Source: https://josr-online.biomedcentral.com/articles/10.1186/s13018-020-01941-x
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