Authors: Satoshi Sasaki Naohisa Miyakoshi Michio Hongo Yuji Kasukawa Yoichi Shimada
Publish Date: 2012/05/19
Volume: 30, Issue: 5, Pages: 561-567
Abstract
Recent reports have raised concerns about lowenergy subtrochanteric and diaphyseal femoral fractures after longterm bisphosphonate treatment which may be associated with severely suppressed bone turnover SSBT However diaphyseal femoral fractures without bisphosphonate treatment have also been reported in patients with severely curved femur which are commonplace in the elderly The purpose of this study was therefore to investigate associations between occurrence of such fractures bisphosphonate use and curvature of the femur Nine consecutive elderly patients treated for lowenergy diaphyseal femoral fractures between 2005 and 2010 were retrospectively reviewed Three patients sustained bilateral fractures Eight patients were administered bisphosphonates and one patient was administered raloxifene Duration of osteoporosis treatment type of fractures surgical procedure cortical thickness and curvature of opposite femur were evaluated The cortical thickness and femoral curvature were further compared with those of 24 control subjects without fractures The mean duration of drug administration was 36 years All fractures showed similar Xray patterns of simple transverse fracture with medial spike Only one femur showed thickening of the femoral cortex One case was treated with locking plate fixation while the other cases were operated with intramedullary nails 9 antegrade nails 2 retrograde nails One femur treated with retrograde nail showed delayed bone union The femoral curvature was significantly higher in the lowenergy fracture group than the control group P 001 however cortical thickness did not show a significant difference between the groups In addition to SSBT increased femoral curvature might be a causative factor for lowenergy diaphyseal femoral fracture in the elderly
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