J Bone Metab.  2014 May;21(2):155-159. 10.11005/jbm.2014.21.2.155.

Atypical Femoral Fracture Combined with Osteonecrosis of Jaw During Osteoporosis Treatment with Bisphosphonate

• Won Y
• Lim JR
• Kim YH
• Song HK
• Yang KH

• KMID: 2241537
• DOI: http://doi.org/10.11005/jbm.2014.21.2.155

Abstract

Bisphosphonate, a potent anti-resorptive agent, is generally accepted as a safe, effective, well tolerated treatment for postmenopausal osteoporosis. Atypical femoral fracture (AFF) and bisphosphonate related osteonecrosis of jaw (BRONJ) are the increasing morbidities in patients treated with long term bisphosphonate. Pathogenic mechanisms of AFF and BRONJ are not fully identified and not identical. We report a case of BRONJ followed by AFF and its nonunion in a 67-year-old woman patient receiving an oral bisphosphonate during 7 years for the treatment of osteoporosis.

Keyword

Atypical femoral fracture; Bisphosphonate

MeSH Terms

Aged
Female
Femoral Fractures*
Humans
Jaw*
Osteonecrosis*
Osteoporosis*
Osteoporosis, Postmenopausal

Figure

• 

  Fig. 1 (A) Preoperative radiograph shows subtrochanteric fracture of left femur: Transverse fracture with medial beak were noticed. (B) Postoperative radiograph after the initial operation.

• 

  Fig. 2 Nonunion and hardware failure developed at seven months after the operation.

• 

  Fig. 3 One year after hardware exchange and auto iliac bone graft for nonunion and hardware breakage. Lateral cortex osteotomy was performed at lateral cortex for sliding (arrow).

• 

  Fig. 4 (A) The dental panoramic view demonstrates osseous sclerosis (arrow) and radiolucent lesion with irregular margin on the mandible. (B) Clinical photo of extracted socket with ulceration. (C) The dental panoramic view after sequestrectomy.

Reference

1. Allen MR, Burr DB. Bisphosphonate effects on bone turnover, microdamage, and mechanical properties: what we think we know and what we know that we don't know. Bone. 2011; 49:56–65.

2. Unnanuntana A, Saleh A, Mensah KA, et al. Atypical femoral fractures: what do we know about them?: AAOS Exhibit Selection. J Bone Joint Surg Am. 2013; 95:e8 1–e8 13.

3. Ruggiero SL, Dodson TB, Assael LA, et al. American Association of Oral and Maxillofacial Surgeons position paper on bisphosphonate-related osteonecrosis of the jaws-2009 update. J Oral Maxillofac Surg. 2009; 67:2–12.

4. Pazianas M, Miller P, Blumentals WA, et al. A review of the literature on osteonecrosis of the jaw in patients with osteoporosis treated with oral bisphosphonates: prevalence, risk factors, and clinical characteristics. Clin Ther. 2007; 29:1548–1558.

5. Giusti A, Hamdy NA, Papapoulos SE. Atypical fractures of the femur and bisphosphonate therapy: a systematic review of case/case series studies. Bone. 2010; 47:169–180.

6. Almăşan HA, Băciuţ M, Rotaru H, et al. Osteonecrosis of the jaws associated with the use of bisphosphonates. Discussion over 52 cases. Rom J Morphol Embryol. 2011; 52:1233–1241.

7. Advisory Task Force on Bisphosphonate-Related Ostenonecrosis of the Jaws. American Association of Oral and Maxillofacial Surgeons. American Association of Oral and Maxillofacial Surgeons position paper on bisphosphonate-related osteonecrosis of the jaws. J Oral Maxillofac Surg. 2007; 65:369–376.

8. Seraphim A, Al-Hadithy N, Mordecai SC, et al. Do bisphosphonates cause femoral insufficiency fractures? J Orthop Traumatol. 2012; 13:171–177.

9. Shane E, Burr D, Abrahamsen B, et al. Atypical subtrochanteric and diaphyseal femoral fractures: second report of a task force of the american society for bone and mineral research. J Bone Miner Res. 2014; 29:1–23.

10. Park-Wyllie LY, Mamdani MM, Juurlink DN, et al. Bisphosphonate use and the risk of subtrochanteric or femoral shaft fractures in older women. JAMA. 2011; 305:783–789.

11. Dell RM, Adams AL, Greene DF, et al. Incidence of atypical nontraumatic diaphyseal fractures of the femur. J Bone Miner Res. 2012; 27:2544–2550.

12. Meier RP, Perneger TV, Stern R, et al. Increasing occurrence of atypical femoral fractures associated with bisphosphonate use. Arch Intern Med. 2012; 172:930–936.

13. Feldstein AC, Black D, Perrin N, et al. Incidence and demography of femur fractures with and without atypical features. J Bone Miner Res. 2012; 27:977–986.

14. Khosla S, Burr D, Cauley J, et al. Bisphosphonate-associated osteonecrosis of the jaw: report of a task force of the American Society for Bone and Mineral Research. J Bone Miner Res. 2007; 22:1479–1491.

15. Ruggiero SL, Mehrotra B, Rosenberg TJ, et al. Osteonecrosis of the jaws associated with the use of bisphosphonates: a review of 63 cases. J Oral Maxillofac Surg. 2004; 62:527–534.

16. Salesi N, Pistilli R, Marcelli V, et al. Bisphosphonates and oral cavity avascular bone necrosis: a review of twelve cases. Anticancer Res. 2006; 26:3111–3115.

17. Reid IR. Osteonecrosis of the jaw: who gets it, and why? Bone. 2009; 44:4–10.

18. Kalyan S, Quabius ES, Wiltfang J, et al. Can peripheral blood gammadelta T cells predict osteonecrosis of the jaw? An immunological perspective on the adverse drug effects of aminobisphosphonate therapy. J Bone Miner Res. 2013; 28:728–735.

19. Hewitt C, Farah CS. Bisphosphonate-related osteonecrosis of the jaws: a comprehensive review. J Oral Pathol Med. 2007; 36:319–328.