股骨粗隆下骨折是罕见且棘手的,因为可能与低骨形成有关。对38例股骨粗隆下骨折患者的回顾性分析显示,有4例患者患有与低骨形成有关的疾病,其中2例具有特定的治疗方法。
目的:本研究的主要目的是检测形态非典型股骨骨折(AFF)患者中潜在的代谢性骨疾病和与低骨形成相关的骨骼发育不良。第二个目标是评估公认的风险因素的频率,如抗吸收剂,糖皮质激素,和年龄。
方法:回顾性分析了在2012年2月至2022年3月期间入住东京大学医院骨科和脊柱外科以及急诊和重症医学科的38例日本患者的临床资料。股骨转子下骨折。
结果:在38例患者(包括30例女性)中,21名患者年龄在75岁及以上。十名患者过去口服糖皮质激素,18人曾经使用过抗吸收剂。两名患者在骨折发展后被诊断为低磷酸盐性骨软化症。一名患者被怀疑是碱性磷酸酶功能丧失变异体的携带者,生物矿化相关(ALPL),另外一名患者此前曾被基因诊断为肾结石症。在四名诊断或怀疑这些代谢性骨疾病和骨骼发育不良的患者中,四个人过去有临床骨折,两个人过去股骨转子下骨折,两例两侧股骨粗隆下骨折。
结论:如果临床医生遇到形态学AFF患者,与低骨形成相关的潜在疾病应仔细区分,因为适当的治疗可以防止延迟愈合和复发性骨折。此外,在开始在骨质疏松患者中长期使用抗再吸收药物之前,可能需要通过血清碱性磷酸酶水平筛查来提前排除这些骨疾病,以降低形态学AFF的风险.
Subtrochanteric femoral fracture is rare and intractable due to the possible association with low bone formation. Retrospective analysis of 38 patients with subtrochanteric femoral fractures revealed that four patients suffered from disorders related to low bone formation and there were specific treatments for two of them.
OBJECTIVE: The main aim of this study was to detect latent metabolic bone diseases and skeletal dysplasia associated with low bone formation among patients with morphologic atypical femoral fracture (AFF). A second aim was to evaluate the frequency of recognized risk factors, such as antiresorptive agents, glucocorticoids, and age.
METHODS: Clinical information was retrospectively analyzed among 38 Japanese patients who were admitted to the Department of Orthopedic Surgery and Spinal Surgery and the Division of Emergency and Critical Care Medicine at the University of Tokyo Hospital with diagnoses of subtrochanteric fractures between February 2012 and March 2022.
RESULTS: Among 38 patients (including 30 females), 21 patients were aged 75 and over. Ten patients had past oral glucocorticoid use, and 18 had past antiresorptive agent use. Two patients were diagnosed with hypophosphatemic osteomalacia after the development of fractures. One patient was suspected to be a carrier of a loss-of-function variant of alkaline phosphatase, biomineralization associated (ALPL), and one other patient had previously been genetically diagnosed with pycnodysostosis. Among four patients with a diagnosis or suspicion of these metabolic bone diseases and skeletal dysplasia, four had past clinical fractures, two had past subtrochanteric femoral fractures, and two had subtrochanteric femoral fractures on both sides.
CONCLUSIONS: If clinicians encounter patients with morphologic AFF, latent diseases related to low bone formation should be carefully differentiated because appropriate treatment may prevent delayed union and recurrent fractures. Additionally, it may be desirable to exclude these bone diseases in advance before initiating long-term use of antiresorptive agents in osteoporotic patients by screening with serum alkaline phosphatase levels to reduce the risk of morphologic AFF.