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Medical Management of Patients After Atypical Femur Fractures: a Systematic Review and Recommendations From the European Calcified Tissue Society

CONTEXT: Atypical femur fractures (AFFs) are serious adverse events associated with bisphosphonates and often show poor healing. EVIDENCE ACQUISITION: We performed a systematic review to evaluate effects of teriparatide, raloxifene, and denosumab on healing and occurrence of AFF. EVIDENCE SYNTHESIS:...

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Autores principales: van de Laarschot, Denise M, McKenna, Malachi J, Abrahamsen, Bo, Langdahl, Bente, Cohen-Solal, Martine, Guañabens, Núria, Eastell, Richard, Ralston, Stuart H, Zillikens, M Carola
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7121199/
https://www.ncbi.nlm.nih.gov/pubmed/31867670
http://dx.doi.org/10.1210/clinem/dgz295
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author van de Laarschot, Denise M
McKenna, Malachi J
Abrahamsen, Bo
Langdahl, Bente
Cohen-Solal, Martine
Guañabens, Núria
Eastell, Richard
Ralston, Stuart H
Zillikens, M Carola
author_facet van de Laarschot, Denise M
McKenna, Malachi J
Abrahamsen, Bo
Langdahl, Bente
Cohen-Solal, Martine
Guañabens, Núria
Eastell, Richard
Ralston, Stuart H
Zillikens, M Carola
author_sort van de Laarschot, Denise M
collection PubMed
description CONTEXT: Atypical femur fractures (AFFs) are serious adverse events associated with bisphosphonates and often show poor healing. EVIDENCE ACQUISITION: We performed a systematic review to evaluate effects of teriparatide, raloxifene, and denosumab on healing and occurrence of AFF. EVIDENCE SYNTHESIS: We retrieved 910 references and reviewed 67 papers, including 31 case reports, 9 retrospective and 3 prospective studies on teriparatide. There were no RCTs. We pooled data on fracture union (n = 98 AFFs on teriparatide) and found that radiological healing occurred within 6 months of teriparatide in 13 of 30 (43%) conservatively managed incomplete AFFs, 9 of 10 (90%) incomplete AFFs with surgical intervention, and 44 of 58 (75%) complete AFFs. In 9 of 30 (30%) nonoperated incomplete AFFs, no union was achieved after 12 months and 4 (13%) fractures became complete on teriparatide. Eight patients had new AFFs during or after teriparatide. AFF on denosumab was reported in 22 patients, including 11 patients treated for bone metastases and 8 without bisphosphonate exposure. Denosumab after AFF was associated with recurrent incomplete AFFs in 1 patient and 2 patients of contralateral complete AFF. Eight patients had used raloxifene before AFF occurred, including 1 bisphosphonate-naïve patient. CONCLUSIONS: There is no evidence-based indication in patients with AFF for teriparatide apart from reducing the risk of typical fragility fractures, although observational data suggest that teriparatide might result in faster healing of surgically treated AFFs. Awaiting further evidence, we formulate recommendations for treatment after an AFF based on expert opinion.
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spelling pubmed-71211992020-04-08 Medical Management of Patients After Atypical Femur Fractures: a Systematic Review and Recommendations From the European Calcified Tissue Society van de Laarschot, Denise M McKenna, Malachi J Abrahamsen, Bo Langdahl, Bente Cohen-Solal, Martine Guañabens, Núria Eastell, Richard Ralston, Stuart H Zillikens, M Carola J Clin Endocrinol Metab Reports and Recommendations CONTEXT: Atypical femur fractures (AFFs) are serious adverse events associated with bisphosphonates and often show poor healing. EVIDENCE ACQUISITION: We performed a systematic review to evaluate effects of teriparatide, raloxifene, and denosumab on healing and occurrence of AFF. EVIDENCE SYNTHESIS: We retrieved 910 references and reviewed 67 papers, including 31 case reports, 9 retrospective and 3 prospective studies on teriparatide. There were no RCTs. We pooled data on fracture union (n = 98 AFFs on teriparatide) and found that radiological healing occurred within 6 months of teriparatide in 13 of 30 (43%) conservatively managed incomplete AFFs, 9 of 10 (90%) incomplete AFFs with surgical intervention, and 44 of 58 (75%) complete AFFs. In 9 of 30 (30%) nonoperated incomplete AFFs, no union was achieved after 12 months and 4 (13%) fractures became complete on teriparatide. Eight patients had new AFFs during or after teriparatide. AFF on denosumab was reported in 22 patients, including 11 patients treated for bone metastases and 8 without bisphosphonate exposure. Denosumab after AFF was associated with recurrent incomplete AFFs in 1 patient and 2 patients of contralateral complete AFF. Eight patients had used raloxifene before AFF occurred, including 1 bisphosphonate-naïve patient. CONCLUSIONS: There is no evidence-based indication in patients with AFF for teriparatide apart from reducing the risk of typical fragility fractures, although observational data suggest that teriparatide might result in faster healing of surgically treated AFFs. Awaiting further evidence, we formulate recommendations for treatment after an AFF based on expert opinion. Oxford University Press 2019-12-23 /pmc/articles/PMC7121199/ /pubmed/31867670 http://dx.doi.org/10.1210/clinem/dgz295 Text en © Endocrine Society 2019. http://creativecommons.org/licenses/by-nc/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Reports and Recommendations
van de Laarschot, Denise M
McKenna, Malachi J
Abrahamsen, Bo
Langdahl, Bente
Cohen-Solal, Martine
Guañabens, Núria
Eastell, Richard
Ralston, Stuart H
Zillikens, M Carola
Medical Management of Patients After Atypical Femur Fractures: a Systematic Review and Recommendations From the European Calcified Tissue Society
title Medical Management of Patients After Atypical Femur Fractures: a Systematic Review and Recommendations From the European Calcified Tissue Society
title_full Medical Management of Patients After Atypical Femur Fractures: a Systematic Review and Recommendations From the European Calcified Tissue Society
title_fullStr Medical Management of Patients After Atypical Femur Fractures: a Systematic Review and Recommendations From the European Calcified Tissue Society
title_full_unstemmed Medical Management of Patients After Atypical Femur Fractures: a Systematic Review and Recommendations From the European Calcified Tissue Society
title_short Medical Management of Patients After Atypical Femur Fractures: a Systematic Review and Recommendations From the European Calcified Tissue Society
title_sort medical management of patients after atypical femur fractures: a systematic review and recommendations from the european calcified tissue society
topic Reports and Recommendations
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7121199/
https://www.ncbi.nlm.nih.gov/pubmed/31867670
http://dx.doi.org/10.1210/clinem/dgz295
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