[BISPHOSPHONATES AS A PREVENTATIVE TREATMENT FOR OSTEOPOROTIC HIP FRACTURES: A MIXED BLESSING]
Uri Barak1, Yoav Rosenthal1, Amir Arami1
1Department of Orthopedic Surgery, Rabin Medical Center (Beilinson Campus), Petah Tikva, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel.
Background:
The widespread use of bisphosphonates for treating osteoporosis in the last two decades has raised concern about the complication of atypical hip fractures secondary to bisphosphonate treatment. These fractures may be the result of a minor trauma to the hip or without any trauma at all. It may be heralded by prodromal groin or hip pain. Prolonged bisphosphonate treatment and atypical fractures may exist, but the nature and the extent of this linkage are still unknown. Currently, there is a lack of adequate evidence-based methods or a consensus about the treatment of this unique phenomenon.
Methods:
We retrospectively examined the records of all subtrochanteric hip fracture cases admitted to our department in the years 2010-2014. During that period, we treated a total of 1315 patients:726 patients with pertrochanteric fractures, 514 patients with subcapital fractures and 75 patients with distal subtrochanteric fractures. Among those, 16 patients (1.2%) qualified as atypical hip fractures. The location of the fracture, period of bisphosphonates use, fixation type, complications and recovery were recorded.
Results:
The average age of the patients in our study was 76.9 years. All patients were treated with bisphosphonates and over 80% of the patients were treated specifically with Alendronate prior to the fracture. Mean treatment time was 7.8 years. Most of the fractures (75%) were subtrochanteric, and the others were at the femur midshaft. All patients received surgical fixation and all accomplished union of the fractures.
Conclusions:
It seems reasonable to assume a causative relationship between a long term use of bisphosphonates and the occurrence of atypical hip fractures. It is a relatively rare complication; nevertheless, it should be kept in mind during a long term use of bisphosphonates. According to our department's clinical experience we found no delay in bone union with these atypical hip fractures. It seems reasonable to prophylactically fixate atypical stress fractures before they become a full fracture.
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