Fri., 10/15/10 Geriatrics, Paper #45, 10:46 am OTA-2010
Operative Outcomes and Treatment Difficulties for Fractures of the Proximal Femur Associated with Bisphosphonate Therapy
Jaimo Ahn, MD1; Omesh Paul, MD2; Paul Matuszewski, MD1; Mark L. Prasarn, MD3;
Andrew S. Neviaser, MD2; Timothy S. Achor, MD4; David L. Helfet, MD2;
Joseph M. Lane, MD2; Dean G. Lorich, MD2;
1University of Pennsylvania, Philadelphia, Pennsylvania, USA;
2Hospital for Special Surgery, New York, New York, USA;
3University of Rochester, Rochester, Minnesota, USA;
4University of Texas, Houston, Houston, Texas, USA
Purpose: Fractures of the proximal femur associated with bisphosphonate therapy are being increasingly recognized as a clinical entity but lack adequate clinical characterization. Our goal was to describe the operative treatment and outcomes including some of the challenges associated with these difficult fractures.
Methods: A retrospective operative database review identified 43 patients with bisphosphonate- associated fractures of the femur between 2002 and 2008. Data were extracted from a final bisphosphonate cohort (BC) of 25 patients and was compared to a similar control cohort (CC) of 20 patients regarding preoperative, intraoperative, and postoperative variables of interest.
Results: The average age of the BC was 71 years (SD = 11) and average follow-up was 83 weeks. Fractures were typically subtrochanteric to middle-third femur (mean of 6 cm subtrochanteric). The average duration of bisphosphonate therapy was 7.6 years. 64% of patients regained preoperative ambulatory status; 18% reported returning to previous living environments. When compared to the CC, the BC had a significantly higher overall complication rate (P < 0.0001)—most notably intraoperative fractures and postoperative plate failures. Furthermore, healing time was delayed compared to controls (26 weeks vs 19 weeks; P = 0.01).
Conclusion: Our data begin to illustrate the difficulties in treatment of these injuries. Intramedullary nailing, which is otherwise standard treatment, was not routine due to a high risk of iatrogenic fractures and plate constructs were prone to failure. Despite the low rate of other risk factors and the ample use of biologic adjuvants, patients have lengthy healing times and a difficult return to preinjury living environments. These fractures require vigilance and appropriately aggressive care from providers and careful further study.
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• The FDA has not cleared this drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off label” use). ◆FDA information not available at time of printing. Δ OTA Grant.