![]() Femoral insufficiency fractures associated with prolonged bisphosphonate therapy. Long-term bisphosphonate usage and subtrochanteric insufficiency fractures: a cause for concern?. Diagnosis of proximal femoral insufficiency fractures in patients receiving bisphosphonate therapy. Patients who present with pain and have early stress reactions (cortical thickening and peaking of the femur) are also often considered for prophylactic operative treatment.Īll patients who present with atypical femoral fractures should have their contralateral femurs imaged with plain radiographs to evaluate for early changes of impending fracture, in which case prophylactic fixation is recommended 12. Healing of atypical fractures and restoration of bone quality can be aided by teriparatide, a recombinant human parathyroid hormone (rhPTH) 7,8. Operative treatment is recommended for all patients with atypical femoral fractures. Intramedullary nailing is the preferred treatment as they are weight sharing devices and promote healing with callus in comparison to plate and screw constructs 11.ĭelayed fracture healing occurs in ~25% of cases 4. T2 and STIR: low signal fracture line diffuse high marrow signalĪfter a diagnosis of an atypical fracture is confirmed (complete or incomplete), antiresorptive treatment should be stopped 10. ![]()
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