Atypical Femur Fractures in Post-Menopausal Patients Taking Bisphosphonates and Their Indication When to Start after Holiday Period of 5 Years and Its Effects
DOI:
https://doi.org/10.54536/ajmsi.v4i1.4156Keywords:
Atypical Femur Fractures, Bisphosphonates, Effects of Bisphosphonate Resumption, Post-Menopausal PatientsAbstract
Postmenopausal women are at risk of fractures owing to osteoporosis, which is worsened by low oestrogen. Bisphosphonates like ibandronate, zoledronic acid, alendronate, and risedronate limit bone resorption and increase bone density, reducing fracture risk. Although atypical femur fractures (AFFs) are uncommon, they are associated with dangerous complications of long-term bisphosphonate therapy. Early fracture identification before they occur is crucial to minimizing complications. The review examines bisphosphonate-related medical issues in postmenopausal women with atypical femur fractures. The study also addressed whether to resume bisphosphonate medication following a pharmacological holiday, which reduces fracture risk. A thorough literature search was undertaken using PubMed, Embase, and the Cochrane Library. The search criteria included atypical femur fractures, bisphosphonates, osteoporosis, and therapy duration. Following screening, studies fulfilling inclusion criteria were assessed utilizing the Cochrane Risk of Bias Tool and Newcastle-Ottawa Scale. Several studies examined the association between long-term bisphosphonate usage and atypical femur fractures. Bisphosphonates reduce osteoporotic fractures but may raise AFF risk over time. The studies also emphasize the significance of individualized bisphosphonate treatment programs and thorough monitoring, especially after a medication holiday. Bisphosphonates reduce fracture risk, although atypical femur fractures require cautious treatment duration and timing, especially following a medication holiday. Selection bias and confounding variables may have limited the evidence of this research. The research design and use of real-world data may also affect its validity and reliability. To enhance treatment recommendations and patient outcomes, longitudinal research on bisphosphonates’ long-term impact on bone health and fracture risk is needed.
Downloads
References
Bauer, D. C., Black, D. M., Dell, R., Fan, B., Smith, C. D., Ernst, M. T., Jurik, A. G., Frøkjær, J. B., Boesen, M., & Vittinghoff, E. (2024). Bisphosphonate Use and Risk of Atypical Femoral Fractures: A Danish Case-Cohort Study With Blinded Radiographic Review. The Journal of Clinical Endocrinology & Metabolism, dgae023. https://doi.org/10.1210/clinem/dgae023
Black, D. M., Abrahamsen, B., Bouxsein, M. L., Einhorn, T., & Napoli, N. (2019). Atypical femur fractures: review of epidemiology, relationship to bisphosphonates, prevention, and clinical management. Endocrine reviews, 40(2), 333-368. https://doi.org/10.1210/er.2018-00001
Brown, J. P. (2021). Long-term treatment of postmenopausal osteoporosis. Endocrinology and Metabolism, 36(3), 544-552. https://doi.org/10.3803/EnM.2021.301
Crawley, J. (2019). BNF Chapter 6: Endocrine System. NHS Retrieved from https://www.coch.nhs.uk/media/172790/6-endocrine-system.pdf
Donnelly, E., Saleh, A., Unnanuntana, A., & Lane, J. M. (2012). Atypical femoral fractures: epidemiology, etiology, and patient management. Current opinion in supportive and palliative care, 6(3), 348-354. https://doi.org/10.1097/SPC.0b013e3283552d7d
Fuggle, N. R., Curtis, B., Clynes, M., Zhang, J., Ward, K., Javaid, M. K., Harvey, N. C., Dennison, E., & Cooper, C. (2021). The treatment gap: the missed opportunities for osteoporosis therapy. Bone, 144, 115833. https://doi.org/10.1016/j.bone.2020.115833
Grygorieva, N., Kovalenko, V., Коrzh, М., Tatarchuk, T., Dedukh, N., Strafun, S., Dubossarska, Z., Protsenko, G., Kalashnikov, A., & Musiіenko, А. (2023). Guideline for diagnostic, prevention and treatment of postmenopausal osteoporosis. Pain, joints, spine, 13(3), 128-154. https://doi.org/10.22141/pjs.13.3.2023.378
Haddaway, N. R., Page, M. J., Pritchard, C. C., & McGuinness, L. A. (2022). PRISMA2020: An R package and Shiny app for producing PRISMA 2020-compliant flow diagrams, with interactivity for optimised digital transparency and Open Synthesis. Campbell systematic reviews, 18(2), e1230. https://doi.org/10.1002/cl2.1230
Hart, D. A. (2023). Are secondary effects of bisphosphonates on the vascular system of bone contributing to increased risk for atypical femoral fractures in osteoporosis? BioEssays, 45(4), 2200206. https://doi.org/10.1002/bies.202200206
Hart, D. A. (2024). Towards understanding how bisphosphonate-dependent alterations to nutrient canal integrity can contribute to risk for atypical femoral fractures: Biomechanical considerations and potential relationship to a real-world analogy. BioEssays, 46(2), 2300117. https://doi.org/10.1002/bies.202300117
Higgins, J. P., Altman, D. G., Gøtzsche, P. C., Jüni, P., Moher, D., Oxman, A. D., Savović, J., Schulz, K. F., Weeks, L., & Sterne, J. A. (2011). The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. Bmj, 343. https://doi.org/10.1136/bmj.d5928
Ji, M. X., & Yu, Q. (2015). Primary osteoporosis in postmenopausal women. Chronic diseases and translational medicine, 1(01), 9-13. https://doi.org/10.1016/j.cdtm.2015.02.006
Khan, A. A., Alrob, H. A., Ali, D. S., Dandurand, K., Wolfman, W., & Fortier, M. (2022). Guideline no. 422g: menopause and osteoporosis. Journal of Obstetrics and Gynaecology Canada, 44(5), 527-536. e525. https://doi.org/10.1016/j.jogc.2021.09.013
McKenna, M. J., McKiernan, F. E., McGowan, B., Silke, C., Bennett, K., Van Der Kamp, S., Ward, P., Hurson, C., & Heffernan, E. (2017). Identifying incomplete atypical femoral fractures with single-energy absorptiometry: declining prevalence. Journal of the Endocrine Society, 1(3), 211-220. https://doi.org/10.1210/js.2016-1118
Moher, D., Liberati, A., Tetzlaff, J., Altman, D. G., & PRISMA Group*, t. (2009). Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Annals of internal medicine, 151(4), 264-269. https://doi.org/10.7326/0003-4819-151-4-200908180-00135
Morkos, M., Mahrous, P., Casagrande, A., Go, M. T., Husni, H., Hanna, M., Goel, M., Bedrose, S., Li, D., & Baim, S. (2022). Patterns of osteoporosis medications selection after drug holiday or continued therapy: a real-world experience. Endocrine Practice, 28(10), 1078-1085. https://doi.org/10.1016/j.eprac.2022.06.011
Ogundipe, O. A. (2020). Nontraumatic bilateral atypical femoral fractures associated with long-term alendronate therapy. Int J Basic Clin Pharmacol, 9, 1737.
Rudran, B., Super, J., Jandoo, R., Babu, V., Nathan, S., Ibrahim, E., & Wiik, A. V. (2021). Current concepts in the management of bisphosphonate associated atypical femoral fractures. World Journal of Orthopedics, 12(9), 660. https://doi.org/10.5312/wjo.v12.i9.660
Saag, K., Cosman, F., De Villiers, T., Langdahl, B., Scott, B., Denker, A., Pong, A., & Santora, A. (2021). Early changes in bone turnover and bone mineral density after discontinuation of long-term oral bisphosphonates: a post hoc analysis. Osteoporosis International, 1-10. https://doi.org/10.1007/s00198-020-05785-3
Silverman, S., Kupperman, E., & Bukata, S. (2018). Bisphosphonate-related atypical femoral fracture: managing a rare but serious complication. Cleve Clin J Med, 85(11), 885-893. https://doi.org/10.3949/ccjm.85a.17119
Tile, L., & Cheung, A. M. (2020). Atypical femur fractures: current understanding and approach to management. Therapeutic Advances in Musculoskeletal Disease, 12, 1759720X20916983. https://doi.org/10.1177/1759720X20916983
Toro, G., Braile, A., Liguori, S., Moretti, A., Landi, G., Cecere, A. B., Conza, G., De Cicco, A., Tarantino, U., & Iolascon, G. (2023). The role of the fracture liaison service in the prevention of atypical femoral fractures. Therapeutic Advances in Musculoskeletal Disease, 15, 1759720X231212747. https://doi.org/10.1177/1759720X231212747
Walker, M. D., & Shane, E. (2023). Postmenopausal osteoporosis. New England Journal of Medicine, 389(21), 1979-1991. https://doi.org/10.1056/NEJMcp2307353
Wells, G. A., Shea, B., O’Connell, D., Peterson, J., Welch, V., Losos, M., & Tugwell, P. (2000). The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses.
Yong, E. L., & Logan, S. (2021). Menopausal osteoporosis: screening, prevention and treatment. Singapore medical journal, 62(4), 159. https://doi.org/10.11622/smedj.2021036
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Imran Azeem, Susan Gilchrist, Kiran Dosani, James Broderick, Conor Hurson
This work is licensed under a Creative Commons Attribution 4.0 International License.
