Background Atypical femoral fractures with low-energy or lack of trauma have been reported to relate using of the bisphosphonates (BPs) and glucocorticoids for a long time, affecting collagen diseases1,2.
Objectives The aim of this study was to analyze the atypical femoral fractures in rheumatic patients in our four institutes retrospectively.
Methods We investigated the cases of atypical femoral fractures summarized by the American Society for Bone and Mineral Research (ASBMR) Task Force 20101 among our out-rheumatic patients from 2009 to 2014.
Results We have 1,091 out-rheumatic patients/year in our four institutes from 2009 to 2014. The patients with atypical femoral fractures were 8 limbs in six women (0.12%) in six years. Three limbs were injured at 2013, and five at 2014, including two cases has both side atypical femoral fractures (Fig. 1). The mean age of them was 51 year-old (38-73). As comorbid conditions, two patients has dermatomyositis, systematic lupus erythematosus, one rheumatoid arthritis and one polyarteritis nodosa. Fracture types were seven subtrochanteric fractures and one diaphyseal femoral fracture. All patients received BPs and prednisolone (PSL). Mean duration of receiving the drugs was 75 months (36-120) and 114 months (60-180), respectively. Mean dosage of PSL was 15 mg/day (5-30). After affecting the fractures, BPs were quitted and the surgery using intramedullary nail fixation were performed in all cases. One case had the surgical-site infection. Teriparatide was induced excepted one case and therapy of low-intensity pulsed ultrasound was started for all cases after healing their operated wounds. Mean duration of post-operative observation was 12 months (5-23). At the latest follow-up, five femurs were observed the sign of union at fracture site on X-ray or computed tomography of their femurs, but not other three femurs. Mean duration of union of the fracture site was 10 months (6-13) in five femurs.
Conclusions Eight atypical femoral fractures were observed in 2013-14, but not in 2009-2012. Atypical femoral fracture may increase year by year. The careful management and treatment for the atypical femoral fractures in rheumatic patients were required even after the surgery, because our all cases have been observed the delayed union or non-union of fracture site at their latest follow-up3.
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Blacks DM, et al. NEJM, 2010.
Thompson RN, et al. JBJS 2012.
Disclosure of Interest None declared
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