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Bisphosphonates and atypical subtrochanteric fractures of the femur

OBJECTIVES: Bisphosphonates are widely used as first-line treatment for primary and secondary prevention of fragility fractures. Whilst they have proved effective in this role, there is growing concern over their long-term use, with much evidence linking bisphosphonate-related suppression of bone re...

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Autores principales: Kharwadkar, N., Mayne, B., Lawrence, J. E., Khanduja, V.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5376663/
https://www.ncbi.nlm.nih.gov/pubmed/28288986
http://dx.doi.org/10.1302/2046-3758.63.BJR-2016-0125.R1
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author Kharwadkar, N.
Mayne, B.
Lawrence, J. E.
Khanduja, V.
author_facet Kharwadkar, N.
Mayne, B.
Lawrence, J. E.
Khanduja, V.
author_sort Kharwadkar, N.
collection PubMed
description OBJECTIVES: Bisphosphonates are widely used as first-line treatment for primary and secondary prevention of fragility fractures. Whilst they have proved effective in this role, there is growing concern over their long-term use, with much evidence linking bisphosphonate-related suppression of bone remodelling to an increased risk of atypical subtrochanteric fractures of the femur (AFFs). The objective of this article is to review this evidence, while presenting the current available strategies for the management of AFFs. METHODS: We present an evaluation of current literature relating to the pathogenesis and treatment of AFFs in the context of bisphosphonate use. RESULTS: Six broad themes relating to the pathogenesis and management of bisphosphonate-related AFFs are presented. The key themes in fracture pathogenesis are: bone microdamage accumulation; altered bone mineralisation and altered collagen formation. The key themes in fracture management are: medical therapy and surgical therapy. In addition, primary prevention strategies for AFFs are discussed. CONCLUSIONS: This article presents current knowledge about the relationship between bisphosphonates and the development of AFFs, and highlights key areas for future research. In particular, studies aimed at identifying at-risk subpopulations and organising surveillance for those on long-term therapy will be crucial in both increasing our understanding of the condition, and improving population outcomes. Cite this article: N. Kharwadkar, B. Mayne, J. E. Lawrence, V. Khanduja. Bisphosphonates and atypical subtrochanteric fractures of the femur. Bone Joint Res 2017;6:144–153. DOI: 10.1302/2046-3758.63.BJR-2016-0125.R1.
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spelling pubmed-53766632017-04-14 Bisphosphonates and atypical subtrochanteric fractures of the femur Kharwadkar, N. Mayne, B. Lawrence, J. E. Khanduja, V. Bone Joint Res Trauma OBJECTIVES: Bisphosphonates are widely used as first-line treatment for primary and secondary prevention of fragility fractures. Whilst they have proved effective in this role, there is growing concern over their long-term use, with much evidence linking bisphosphonate-related suppression of bone remodelling to an increased risk of atypical subtrochanteric fractures of the femur (AFFs). The objective of this article is to review this evidence, while presenting the current available strategies for the management of AFFs. METHODS: We present an evaluation of current literature relating to the pathogenesis and treatment of AFFs in the context of bisphosphonate use. RESULTS: Six broad themes relating to the pathogenesis and management of bisphosphonate-related AFFs are presented. The key themes in fracture pathogenesis are: bone microdamage accumulation; altered bone mineralisation and altered collagen formation. The key themes in fracture management are: medical therapy and surgical therapy. In addition, primary prevention strategies for AFFs are discussed. CONCLUSIONS: This article presents current knowledge about the relationship between bisphosphonates and the development of AFFs, and highlights key areas for future research. In particular, studies aimed at identifying at-risk subpopulations and organising surveillance for those on long-term therapy will be crucial in both increasing our understanding of the condition, and improving population outcomes. Cite this article: N. Kharwadkar, B. Mayne, J. E. Lawrence, V. Khanduja. Bisphosphonates and atypical subtrochanteric fractures of the femur. Bone Joint Res 2017;6:144–153. DOI: 10.1302/2046-3758.63.BJR-2016-0125.R1. 2017-04-03 /pmc/articles/PMC5376663/ /pubmed/28288986 http://dx.doi.org/10.1302/2046-3758.63.BJR-2016-0125.R1 Text en © 2017 Khanduja et al. This is an open-access article distributed under the terms of the Creative Commons Attributions licence (CC-BY-NC), which permits unrestricted use, distribution, and reproduction in any medium, but not for commercial gain, provided the original author and source are credited.
spellingShingle Trauma
Kharwadkar, N.
Mayne, B.
Lawrence, J. E.
Khanduja, V.
Bisphosphonates and atypical subtrochanteric fractures of the femur
title Bisphosphonates and atypical subtrochanteric fractures of the femur
title_full Bisphosphonates and atypical subtrochanteric fractures of the femur
title_fullStr Bisphosphonates and atypical subtrochanteric fractures of the femur
title_full_unstemmed Bisphosphonates and atypical subtrochanteric fractures of the femur
title_short Bisphosphonates and atypical subtrochanteric fractures of the femur
title_sort bisphosphonates and atypical subtrochanteric fractures of the femur
topic Trauma
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5376663/
https://www.ncbi.nlm.nih.gov/pubmed/28288986
http://dx.doi.org/10.1302/2046-3758.63.BJR-2016-0125.R1
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