Sat., 10/15/11 Peds, Ger, Hip, Femur & IP, Paper #73, 10:46 am OTA-2011
Surgical Treatment Improves Clinical and Functional Outcomes for Patients Who Sustain Incomplete Bisphosphanate-Induced Femur Fractures
Kenneth A. Egol, MD; Colin J. Prensky, BA; Ji Hae Park, BS;
Zehava S. Rosenberg, MD; Nirmal C. Tejwani, MD;
NYU Hospital for Joint Diseases, New York, New York, USA
Purpose: Recently increasing evidence has shown a pattern of subtrochanteric femur fractures associated with long-term bisphosphonate use. The purpose of this study is to describe the ultimate outcomes for patients treated at a single institution, for incomplete bisphosphonate-induced femoral fractures.
Methods: Between 2004 and 2011, 65 patients with 101 femur fractures were identified as having radiographic findings consistent with bisphosphonate-induced atypical femur fractures and were enrolled in our database. Incomplete fractures were defined by a pattern of lateral cortical thickening on radiographs with or without obvious fracture. For all incomplete fractures, bisphosphonate therapy was discontinued and patients were treated with conservative management. Surgery was performed for fractures with refractory symptoms or failure to alter radiographs with nonsurgical treatment. 34 patients with 47 incomplete fractures were identified and analyzed. Three patients with four fractures went on to complete fractures and were excluded from this study. Patients were assessed at a mean 16.4 months with the Short Musculoskeletal Functional Assessment (SMFA). Patient demographics, initial radiographic diagnosis, treatment modality, time to healing, and self-reported functional status were retrospectively documented. Healing was documented radiographically. Functional status and clinical data were analyzed by Student t test and Fisher exact test.
Results: This cohort had been treated with bisphosphonates for an average of 10 years (range, 7-15 years). The average healing time for all incomplete fractures was 8.2 months (range, 1.5-24 months), with 2 fractures failing to unite at latest follow-up. 50% of fractures were ultimately treated with surgery for failure of or pain refractory to nonsurgical management. At latest follow-up, 91% of patients treated with surgery reported no pain and 78% of fractures were radiographically united. 71% of surgical patients self-reported a return to baseline functional status. In contrast, 31% of nonoperative patients were asymptomatic at latest follow-up with 31% of fractures showing radiographic evidence of healing. Standardized dysfunction index from the SMFA was 19.7 in the surgical group and 25.7 in the nonsurgical group (P = 0.0017).
Conclusions: While bisphosphonate therapy is an important tool in the fight against postmenopausal vertebral fractures and typical hip fractures, its long-term use is not without risk. We found that nearly half of the patients with nondisplaced bisphosphonate-induced femoral fractures ultimately required surgical intervention for relief of symptoms. At an average of 16.4 months, patients who had surgery reported significantly better functional outcomes according to the SMFA. Functional outcomes support radiographic findings and clinical signs of healing. Surgical intervention is effective for relief of symptoms when treating incomplete bisphosphonate-induced femur fractures and patients should be advised of the potential benefits of prophylactic surgery.
Alphabetical Disclosure Listing (628K PDF)
• 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.