Atypische femurfracturen: overzicht van de epidemiologie en de behandeling aan de hand van een casus

Abstract

Atypical femoral fractures: overview of epidemiology and treatment through a case study Atypical femoral fractures are a rare side-effect of the long-term use of antiresorptive medication, like bisphosphonates or denosumab. This article presents the case of a 73-year-old woman suffering from bilateral atypical fractures of the femur after treatment with bisphosphonates and denosumab. She had a Trendelenburg gait at the presentation and little pain. Furthermore, she was treated with low-dose glucocorticoids for rheumatoid arthritis, which is a known risk factor for atypical fractures. This is an interesting case because the first and most frequent complaint of bilateral atypical fractures is generally pain in the thigh or groin. This patient had, however, few pain complaints. Observational data show an association between bisphosphonates, glucocorticoids and atypical femoral fractures. These data are lacking for denosumab as it entered the market more recently. The risk for atypical fractures decreases rapidly after the discontinuation of bisphosphonates, with 70% per year. The patient developed these fractures within the year after starting denosumab and stopping bisphosphonates. It is possible that her prior treatment with bisphosphonates had an impact on the development of her fractures. Orthopedic management is recommended for complete atypical femoral fractures and incomplete fractures accompanied with pain. Conservative therapy with limited weight bearing can be considered for incomplete fractures with minimal pain. Medical management of the fracture consists of calcium and vitamin D supplementation, and discontinuation of the antiresorptive therapy. There is limited evidence for improved healing with teriparatide in surgically treated fractures.