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Treatment options vary in patients with bisphosphonate-related femur fractures
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WAIKOLOA, Hawaii — Surgeons should stop bisphosphonates in patients with bisphosphonate related femur fractures at the start of treatment and treatment options may vary, according to a presenter at Orthopedics Today Hawaii.
“At the same time when we identify these patients with bisphosphonate fractures, we should probably stop their bisphosphonates, back them up with nutritional supplements, and get primary care involved,” Frank A. Liporace, MD, said during his presentation. “Maybe consider Forteo and other things to help them if they are very severely osteoporotic, but we should for at least a minimum of 3 months stop the bisphosphonates.”
He added, “With 100% of these patients, we really should quiz them about their other side, if they have this strange pain going on. We should get a nice-ray, it’s inexpensive, low-risk and can help a problem before it happens on the other side as well.”
Liporace said bisphosphonate fractures are the most difficult fractures to manage because the anatomy of the bone changed so the fragments do not line up perfectly.
He said the preferred management is to prophylactically nail these types of fractures compared with a plate. To determine if prophylactic nailing is the right management for a patient, patients should first be quizzed to determine if they have pain on the other side such as spine hip or arthritis. If so, X-rays and screening films should be evaluated.
“If there are changes it would make sense [to use prophylactic nails], if there are no changes but there is certainly pain and we ruled out other things, [an] MRI is probably a good idea,” he said.
He said plating should be used as an adjunct in revisions, as a reduction tool, but it does not always make a lot of sense to use plates because they are affected by bisphosphonates that may impact primary bone healing.
“...Medialize starting plate, prevent lateralization, plate being anterolateral prevents varus flexion and gives you a little provisional stability, you are not going crazy with 50 screws in the plate. You are able to nail it, get the right alignment and allow for early weightbearing and you can see down the road you can see them healing uneventfully, maintaining axis, which is number one and not having any more pain”– by Monica Jaramillo
Reference:
Liporace FA. Case Presentation: Bisphosphonate Related Femur Fracture. Presented at: Orthopedics Today Hawaii; Jan. 13-17, 2019; Waikoloa, Hawaii.
Disclosures: Liporace reports he is an educational consultant for Depuy and Biomet.