Atypical femoral fractures from bisphosphonate in cancer patients - Review.

• 发表时间: Oct 2019
• 来源期刊: J Bone Oncol
• DOI: 10.1016/j.jbo.2019.100259
• PMID: 31497503
• 文章类型: Journal Article
• 作者列表: Lockwood M,Banderudrappagari R,Suva LJ,Makhoul I

关键词: AFF, atypical femur fracture; AGE, advanced glycation end products; ASBMR, American Society of Bone and Mineral Research; Atypical femur fracture; BP, bisphosphonate; Bisphosphonates; Bone metastasis; Bone remodeling; CI, confidence interval; CT, computed tomography; Denosumab; GGPPS, geranyl geranyl pyrophosphate synthase Her2, human epidermal growth factor receptor; IM, intramedullary; IV, intravenous; MGUS, monoclonal gammopathy of unknown significance; MRI, magnetic resonance imaging; ONJ, osteonecrosis of the jaw; OR, odds ratio; ORIF, open reduction internal fixation; RCT, randomized clinical trial; VEGF, vascular endothelial growth factor

Abstract

Bisphosphonates are commonly used in patients with metastatic bone disease to prevent skeletal related events. Atypical femur fracture is a known complication of long-term bisphosphonate use but the incidence in cancer patients and pathogenesis are not well known. Several mechanisms of pathogenesis have been proposed including altered angiogenesis, altered bone mechanical properties, micro damage and bone remodeling suppression. Atypical femur fractures are atraumatic or minimally traumatic fractures in the sub trochanteric region or the femoral shaft. Awareness of atypical femur fractures is critical to diagnose and treat them in a timely manner. There is a paucity of data regarding the management of atypical femur fracture in patients with malignancy. Management options of atypical femur fractures include stopping bisphosphonates, initiating calcium/vitamin D supplementation and either surgery with internal fixation or conservative management. In the future, it will be important to explore the effect of continuous vs. intermittent exposure, cumulative dose and length of exposure on the incidence of this complication. Herein, we review the epidemiology, risk factors, management options and proposed mechanisms of pathogenesis of atypical femur fractures.