Sat., 10/6/12 Femur/Tibial Fx/Knee Injuries, PAPER #71, 8:23 am OTA-2012
Clinical and Functional Outcomes in Patients Who Sustained Bisphosphonate-Associated Complete Femur Fractures
Kenneth A. Egol, MD; Ji Hae Park, BS; Zehava Sadka Rosenberg, MD; Valerie H. Peck, MD;
Nirmal C. Tejwani, MD;
NYU Hospital for Joint Diseases, New York, New York, USA
Purpose: Recent literature provides substantial evidence that long-term bisphosphonate therapy is associated with atypical subtrochanteric and diaphyseal femur fractures in a small subgroup of patients. Increasing evidence also suggests that incomplete femur fractures may progress to complete fractures without surgical intervention. The purpose of this study is to evaluate the ultimate outcomes of patients, treated at a single institution, with complete atypical femur fractures associated with long-term bisphosphonate use.
Methods: Between 2004 and 2011, 68 patients with 101 atypical femur fractures associated with long-term bisphosphonate use were identified and enrolled in this IRB-approved study. Fractures were classified as incomplete or complete. Patient demographics, initial radiographic diagnosis, treatment modality, time to healing, and self-reported functional status were retrospectively documented. Patients were contacted via telephone at a mean 30 months from date of fracture presentation (range, 6-85 months) to complete the Short Musculoskeletal Function Assessment (SMFA). The SMFA was used to gauge baseline as well as postintervention functional status. Patients who had not yet reached the 6-month follow-up interval and those who could not be contacted for follow-up questions were excluded from functional analysis. Data were analyzed by Student t -test and Fisher exact test.
Results: Patients had been treated with bisphosphonates for an average of 8.5 years (range, 2-20) prior to presentation. The final cohort consisted of 34 patients with 42 complete atypical femur fractures subsequent to low-energy trauma who underwent surgery. Patients reported a mean of 6 months of pain prior to injury (range, 1-8 months). 67% of surgically treated complete fractures became pain-free and 93% were radiographically healed by 12 months. 65% of patients who underwent intramedullary nailing reported a functional return to baseline within 1 year. Patients who reported significant functional limitations at latest follow- up listed pain and apprehension as the major causes of their limitation.
Conclusion: Patients who sustain bisphosphonate-associated complete femur fractures and are treated surgically can expect to return to baseline within 1 year and should be counseled as such. Functional outcomes support radiographic findings and clinical signs of healing. Patients should be advised of the potential risk of sustaining a complete fracture and of the benefits of preventative surgical treatment.
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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.