High and pointed type of femoral localized reaction frequently extends to complete and incomplete atypical femoral fracture in patients with ... View Full Text


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Article Info

DATE

2017-04-13

AUTHORS

H. Sato, N. Kondo, T. Nakatsue, Y. Wada, J. Fujisawa, J. J. Kazama, T. Kuroda, Y. Suzuki, M. Nakano, N. Endo, I. Narita

ABSTRACT

Once a localized reaction (beaking) was detected, discontinuation of bisphosphonates (BPs) and switching to vitamin D supplementation or teriparatide therapy effectively improved its shape. When the localized reaction was high, of the pointed type, and/or accompanied by prodromal pain, the risks of complete and incomplete atypical femoral fracture increased and consideration of prophylactic fixation for such patients was required.IntroductionFemoral localized reaction (localized periosteal thickening of the lateral cortex, beaking) is reported to precede atypical femoral fractures (AFFs) and to develop in 8–10% of patients with autoimmune diseases taking BPs and glucocorticoids. The aims of the present study were to retrospectively investigate the shapes of localized reaction to consider how to manage the condition.MethodsTwenty femora of 12 patients with autoimmune diseases who were on BPs and glucocorticoids exhibited femoral localized reaction. The heights of localized reaction were measured and the shapes classified as pointed, arched, and other. Localized reaction changes were divided into three categories: deterioration, no change, and improvement. A severe form of localized reaction was defined; this was associated with prodromal pain, de novo complete AFF, or incomplete AFF with a fracture line at the localized reaction.ResultsThe mean height of localized reaction was 2.3 ± 0.8 mm (range, 1.0–3.7 mm) and the pointed type was 35%. Localized reaction was significantly higher (3.3 ± 0.8 vs. 2.1 ± 0.7 mm; p = 0.003) and the pointed type more common (78 vs. 27%; p = 0.035) in those with the severe form of localized reaction. Seven patients with localized reactions discontinued BPs just after localized reaction was detected, but five continued on BPs for 2 years. Localized reaction deterioration was more common in patients who continued than discontinued BPs (100 vs. 29%; p = 0.027). After 2 years, all patients had discontinued BPs and localized reaction did not deteriorate further in any patient.ConclusionsOnce a localized reaction was detected, discontinuation of BPs and switching to vitamin D supplementation or teriparatide therapy effectively improved it. When the localized reaction was high, of the pointed type, and/or accompanied by prodromal pain, the risks of complete and incomplete AFF increased and consideration of prophylactic fixation for such patients was required. More... »

PAGES

2367-2376

Identifiers

URI

http://scigraph.springernature.com/pub.10.1007/s00198-017-4038-8

DOI

http://dx.doi.org/10.1007/s00198-017-4038-8

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1084819949

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/28409215


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29 schema:description Once a localized reaction (beaking) was detected, discontinuation of bisphosphonates (BPs) and switching to vitamin D supplementation or teriparatide therapy effectively improved its shape. When the localized reaction was high, of the pointed type, and/or accompanied by prodromal pain, the risks of complete and incomplete atypical femoral fracture increased and consideration of prophylactic fixation for such patients was required.IntroductionFemoral localized reaction (localized periosteal thickening of the lateral cortex, beaking) is reported to precede atypical femoral fractures (AFFs) and to develop in 8–10% of patients with autoimmune diseases taking BPs and glucocorticoids. The aims of the present study were to retrospectively investigate the shapes of localized reaction to consider how to manage the condition.MethodsTwenty femora of 12 patients with autoimmune diseases who were on BPs and glucocorticoids exhibited femoral localized reaction. The heights of localized reaction were measured and the shapes classified as pointed, arched, and other. Localized reaction changes were divided into three categories: deterioration, no change, and improvement. A severe form of localized reaction was defined; this was associated with prodromal pain, de novo complete AFF, or incomplete AFF with a fracture line at the localized reaction.ResultsThe mean height of localized reaction was 2.3 ± 0.8 mm (range, 1.0–3.7 mm) and the pointed type was 35%. Localized reaction was significantly higher (3.3 ± 0.8 vs. 2.1 ± 0.7 mm; p = 0.003) and the pointed type more common (78 vs. 27%; p = 0.035) in those with the severe form of localized reaction. Seven patients with localized reactions discontinued BPs just after localized reaction was detected, but five continued on BPs for 2 years. Localized reaction deterioration was more common in patients who continued than discontinued BPs (100 vs. 29%; p = 0.027). After 2 years, all patients had discontinued BPs and localized reaction did not deteriorate further in any patient.ConclusionsOnce a localized reaction was detected, discontinuation of BPs and switching to vitamin D supplementation or teriparatide therapy effectively improved it. When the localized reaction was high, of the pointed type, and/or accompanied by prodromal pain, the risks of complete and incomplete AFF increased and consideration of prophylactic fixation for such patients was required.
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35 schema:keywords ConclusionsOnce
36 D supplementation
37 ResultsThe
38 aim
39 atypical femoral fractures
40 autoimmune diseases
41 bisphosphonates
42 categories
43 changes
44 complete atypical femoral fractures
45 conditions
46 consideration
47 deterioration
48 discontinuation
49 discontinuation of bisphosphonates
50 disease
51 femoral fractures
52 femur
53 fixation
54 form
55 fracture line
56 fractures
57 glucocorticoids
58 height
59 improvement
60 incomplete atypical femoral fractures
61 lines
62 localized reactions
63 long-term glucocorticoids
64 pain
65 patients
66 pointed type
67 present study
68 prodromal pain
69 prophylactic fixation
70 reaction
71 reaction changes
72 risk
73 severe form
74 shape
75 study
76 such patients
77 supplementation
78 teriparatide therapy
79 therapy
80 types
81 vitamin D supplementation
82 years
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