Please use this identifier to cite or link to this item: https://doi.org/10.1016/j.injury.2010.12.019
Title: Femoral shaft fractures in the elderly - Role of prior bisphosphonate therapy
Authors: Ng, Y.H.
Gino, P.D.
Lingaraj, K. 
Das De, S. 
Keywords: Alendronate
Bisphosphonates
Elderly
Femoral shaft fracture
Insufficiency fracture
Low impact
Prodromal pain
Radiographic features
Treatment protocol
Issue Date: Jul-2011
Citation: Ng, Y.H., Gino, P.D., Lingaraj, K., Das De, S. (2011-07). Femoral shaft fractures in the elderly - Role of prior bisphosphonate therapy. Injury 42 (7) : 702-706. ScholarBank@NUS Repository. https://doi.org/10.1016/j.injury.2010.12.019
Abstract: Introduction: There is a recent surge in interest on bisphosphonate related femoral fractures. Most studies have examined subtrochanteric fractures in patients on long-term bisphosphonates. This study evaluates the characteristics of low-impact femoral shaft fractures in elderly patients on long-term alendronate. Materials and methods: All patients above 60 years old admitted to the National University Hospital for femoral shaft fracture from January 2003 to January 2007 were retrospectively analysed. Of the 55 patients included, 7 had prior alendronate therapy and were examined in detail. Results: All 7 patients on prior alendronate therapy sustained their fractures by low-impact or atraumatic mechanisms of injury. 5 of these 7 patients exhibited a characteristic fracture pattern of thickened lateral cortices at the proximal fracture fragment (p < 0.05) and all 7 patients had either transverse or short oblique fractures. Notably, none of the 7 patients had bone mineral density scans prior to their fractures. One patient was started on alendronate after a vertebral compression fracture, whilst the other 6 patients were started on alendronate without any clear clinical indication. All 7 patients reported prodromal thigh pain 3 weeks to 2 years prior to the fracture. Conclusions: Low-impact femoral shaft fractures in elderly patients on long-term alendronate therapy represent a new entity of insufficiency fractures, with characteristic low-impact modes of injury and fracture patterns on radiograph. Prodromal thigh pain is a warning sign for impending fracture in this group of patients and should be evaluated closely. Teriparatide is a possible alternative to alendronate following such a fracture though more long-term clinical studies are required. © 2010 Elsevier Ltd. All rights reserved.
Source Title: Injury
URI: http://scholarbank.nus.edu.sg/handle/10635/125331
ISSN: 00201383
DOI: 10.1016/j.injury.2010.12.019
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