Please use this identifier to cite or link to this item:
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
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.
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
ISSN: 00201383
DOI: 10.1016/j.injury.2010.12.019
Appears in Collections:Staff Publications

Show full item record
Files in This Item:
There are no files associated with this item.


checked on Oct 21, 2021


checked on Oct 14, 2021

Page view(s)

checked on Oct 14, 2021

Google ScholarTM



Items in DSpace are protected by copyright, with all rights reserved, unless otherwise indicated.