BoneKEy Reports | BoneKEy Watch
Intermedullary nailing is an effective treatment for BP-related femoral fractures
DOI:10.1038/bonekey.2013.153
Atypical femoral fractures are known to be a risk of bisphosphonate (BP) therapy, but the outcome of treating such fractures has not been well studied. Egol et al. followed 33 patients who had been on BPs for 5 years or more and who had atypical, low-impact fractures in one or both femurs after surgery to introduce intramedullary nails.
The first thing the authors noted was that patients presenting with an atypical femoral fracture had a mean of 6 months of pain before they sought treatment. Once diagnosed and treated surgically, 66% of patients were free of pain and showed radiographic healing by the 12-month follow-up. Some 64% said they had fully recovered, in that their function had returned to baseline.
Patients whose fractures showed delayed healing reported continued pain and ‘apprehension’, which prevented them from returning to full health. The authors suggest that misalignment of the fracture during surgery may be a factor.
Editor’s comment: Despite the fractures in these patients being atypical and due to BP use, the use of intramedullary nailing is an effective treatment that achieves complete fracture healing in the majority of patients. The authors also highlight that the prodromal pain reported by patients, which may indicate that fracture is imminent, should be recognized early so that preventative measures can be taken.
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