Current concepts in the management of bisphosphonate associated atypical femoral fractures  

作　　者：Branavan Rudran Jonathan Super Rajan Jandoo Victor Babu Soosai Nathan Edward Ibrahim Anatole Vilhelm Wiik 

机构地区：[1]Department of Orthopaedic Surgery,Chelsea and Westminster NHS Trust,London TW76AF,United Kingdom [2]The MSk Lab,Imperial College London,London W120BZ,United Kingdom [3]Department of Surgery and Cancer,Charing Cross Hospital,London W68RF,United Kingdom

出　　处：《World Journal of Orthopedics》2021年第9期660-671,共12页世界骨科杂志（英文版）

摘　　要：Bisphosphonates are a class of drugs used as the mainstay of treatment for osteoporosis.Bisphosphonates function by binding to hydroxyapatite,and subsequently targeting osteoclasts by altering their ability to resorb and remodel bone.Whilst aiming to reduce the risk of fragility fractures,bisphosphonates have been associated with atypical insufficiency fractures,specifically in the femur.Atypical femoral fractures occur distal to the lesser trochanter,until the supracondylar flare.There are a number of the differing clinical and radiological features between atypical femoral fractures and osteoporotic femoral fractures,indicating that there is a distinct difference in the respective underlying pathophysiology.At the point of presentation of an atypical femoral fracture,bisphosphonate should be discontinued.This is due to the proposed inhibition of osteoclasts and apoptosis,resulting in impaired callus healing.Conservative management consists primarily of cessation of bisphosphonate therapy and partial weightbearing activity.Nutritional deficiencies should be investigated and appro-priately corrected,most notably dietary calcium and vitamin D.Currently there is no established treatment guidelines for either complete or incomplete fractures.There is agreement in the literature that nonoperative management of bisphosphonate-associated femoral fractures conveys poor outcomes.Currently,the favoured methods of surgical fixation are cephalomedullary nailing and plate fixation.Newer techniques advocate the use of both modalities as it gives the plate advantage of best reducing the fracture and compressing the lateral cortex,with the support of the intramedullary nail to stabilise an atypical fracture with increased ability to load-share,and a reduced bending moment across the fracture site.The evidence suggests that cephalomedullary nailing of the fracture has lower revision rates.However,it is important to appreciate that the anatomical location and patient factors may not always allow for this.Although causation betwee

关 键 词：BISPHOSPHONATES Atypical fracture Surgical fixation Atypical femoral fracture OSTEOPOROSIS 

分 类 号：R683.42[医药卫生—骨科学]