Advertisement

Five cases of atypical ulnar fractures associated with long-term bisphosphonate use: An anatomical and mechanical analysis using a finite element model

Published:November 14, 2022DOI:https://doi.org/10.1016/j.jos.2022.09.017
      Bisphosphonates have shown robust efficacy in preventing fractures and are widely prescribed for patients with osteoporosis, a musculoskeletal disease characterized by low bone mass [
      • Black D.M.
      • Bauer D.C.
      • Schwartz A.V.
      • Cummings S.R.
      • Rosen C.J.
      Continuing bisphosphonate treatment for osteoporosis–for whom and for how long?.
      ,
      • Liu W.
      • Yang L.H.
      • Kong X.C.
      • An L.K.
      • Wang R.
      Meta-analysis of osteoporosis: fracture risks, medication and treatment.
      ,
      • Whitaker M.
      • Guo J.
      • Kehoe T.
      • Benson G.
      Bisphosphonates for osteoporosis–where do we go from here?.
      ]. Approximately 12.8 million Japanese individuals have osteoporosis, and 30–50% of American women with osteoporosis are affected by fragility fractures [
      • Saito T.
      • Sterbenz J.M.
      • Malay S.
      • Zhong L.
      • MacEachern M.P.
      • Chung K.C.
      Effectiveness of anti-osteoporotic drugs to prevent secondary fragility fractures: systematic review and meta-analysis.
      ,
      • Yoshimura N.
      • Muraki S.
      • Oka H.
      • Kawaguchi H.
      • Nakamura K.
      • Akune T.
      Cohort profile: research on osteoarthritis/Osteoporosis against Disability study.
      ]. Several studies have revealed an association between bisphosphonate use and atypical fractures of the femoral shaft or subtrochanteric region [
      • Schilcher J.
      • Koeppen V.
      • Aspenberg P.
      • Michaëlsson K.
      Risk of atypical femoral fracture during and after bisphosphonate use.
      ,
      • Dell R.M.
      • Adams A.L.
      • Greene D.F.
      • Funahashi T.T.
      • Silverman S.L.
      • Eisemon E.O.
      • et al.
      Incidence of atypical nontraumatic diaphyseal fractures of the femur.
      ,
      • Meier R.P.
      • Perneger T.V.
      • Stern R.
      • Rizzoli R.
      • Peter R.E.
      Increasing occurrence of atypical femoral fractures associated with bisphosphonate use.
      ]. It has been shown that long-term suppression of bone turnover and suppressed bone remodeling from prolonged exposure to bisphosphonates may lead to an accumulation of microdamage [
      • Schilcher J.
      • Koeppen V.
      • Aspenberg P.
      • Michaëlsson K.
      Risk of atypical femoral fracture during and after bisphosphonate use.
      ,
      • Giusti A.
      • Hamdy N.A.
      • Papapoulos S.E.
      Atypical fractures of the femur and bisphosphonate therapy: a systematic review of case/case series studies.
      ].

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of Orthopaedic Science
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Black D.M.
        • Bauer D.C.
        • Schwartz A.V.
        • Cummings S.R.
        • Rosen C.J.
        Continuing bisphosphonate treatment for osteoporosis–for whom and for how long?.
        N Engl J Med. 2012 May 31; 366: 2051-2053
        • Liu W.
        • Yang L.H.
        • Kong X.C.
        • An L.K.
        • Wang R.
        Meta-analysis of osteoporosis: fracture risks, medication and treatment.
        Minerva Med. 2015 Aug; 106: 203-214
        • Whitaker M.
        • Guo J.
        • Kehoe T.
        • Benson G.
        Bisphosphonates for osteoporosis–where do we go from here?.
        N Engl J Med. 2012 May 31; 366: 2048-2051
        • Saito T.
        • Sterbenz J.M.
        • Malay S.
        • Zhong L.
        • MacEachern M.P.
        • Chung K.C.
        Effectiveness of anti-osteoporotic drugs to prevent secondary fragility fractures: systematic review and meta-analysis.
        Osteoporos Int. 2017 Dec; 28: 3289-3300
        • Yoshimura N.
        • Muraki S.
        • Oka H.
        • Kawaguchi H.
        • Nakamura K.
        • Akune T.
        Cohort profile: research on osteoarthritis/Osteoporosis against Disability study.
        Int J Epidemiol. 2010 Aug; 39: 988-995
        • Schilcher J.
        • Koeppen V.
        • Aspenberg P.
        • Michaëlsson K.
        Risk of atypical femoral fracture during and after bisphosphonate use.
        Acta Orthop. 2015 Feb; 86: 100-107
        • Dell R.M.
        • Adams A.L.
        • Greene D.F.
        • Funahashi T.T.
        • Silverman S.L.
        • Eisemon E.O.
        • et al.
        Incidence of atypical nontraumatic diaphyseal fractures of the femur.
        J Bone Miner Res. 2012 Dec; 27: 2544-2550
        • Meier R.P.
        • Perneger T.V.
        • Stern R.
        • Rizzoli R.
        • Peter R.E.
        Increasing occurrence of atypical femoral fractures associated with bisphosphonate use.
        Arch Intern Med. 2012 Jun; 172: 930-936
        • Giusti A.
        • Hamdy N.A.
        • Papapoulos S.E.
        Atypical fractures of the femur and bisphosphonate therapy: a systematic review of case/case series studies.
        Bone. 2010 Aug; 47: 169-180
        • Tan S.H.
        • Saseendar S.
        • Tan B.H.
        • Pawaskar A.
        • Kumar V.P.
        Ulnar fractures with bisphosphonate therapy: a systematic review of published case reports.
        Osteoporos Int. 2015 Feb; 26: 421-429
        • Asano Y.
        • Tajiri K.
        • Yagishita S.
        • Nakanishi H.
        • Ishii T.
        Bilateral atypical ulnar fractures occurring after long-term treatment with bisphosphonate for 7 years and with teriparatide for 2 years: a case report.
        Osteoporos Int. 2020 Dec; 31: 2473-2476
        • Yam M.G.
        • Kwek E.B.
        A case of bilateral atypical ulnar fractures with bisphosphonate therapy in a walking aided elderly.
        Ann Acad Med Singapore. 2017 Sep; 46: 351-353
        • Skahen 3rd, J.R.
        • Palmer A.K.
        • Werner F.W.
        • Fortino M.D.
        The interosseous membrane of the forearm: anatomy and function.
        J Hand Surg Am. 1997 May; 22: 981-985
        • Haider I.T.
        • Schneider P.
        • Michalski A.
        • Edwards W.B.
        Influence of geometry on proximal femoral shaft strains: implications for atypical femoral fracture.
        Bone. 2018 May; 110: 295-303
        • Oh Y.
        • Fujita K.
        • Wakabayashi Y.
        • Kurosa Y.
        • Okawa A.
        Location of atypical femoral fracture can be determined by tensile stress distribution influenced by femoral bowing and neck-shaft angle: a CT-based nonlinear finite element analysis model for the assessment of femoral shaft loading stress.
        Injury. 2017 Dec; 48: 2736-2743
        • Noda K.
        • Goto A.
        • Murase T.
        • Sugamoto K.
        • Yoshikawa H.
        • Moritomo H.
        Interosseous membrane of the forearm: an anatomical study of ligament attachment locations.
        J Hand Surg Am. 2009 Mar; 34: 415-422
        • Molinier F.
        • Laffosse J.M.
        • Bouali O.
        • Tricoire J.L.
        • Moscovici J.
        The anconeus, an active lateral ligament of the elbow: new anatomical arguments.
        Surg Radiol Anat. 2011 Sep; 33: 617-621
        • Keener J.D.
        • Chafik D.
        • Kim H.M.
        • Galatz L.M.
        • Yamaguchi K.
        Insertional anatomy of the triceps brachii tendon.
        J Shoulder Elbow Surg. 2010 Apr; 19: 399-405
        • Abé H.
        • Hayashi K.
        • Sato M.
        Data book on mechanical properties of living cells, tissues, and organs.
        Springer, 1996
        • Osada R.
        • Zukawa M.
        • Kimura T.
        Atypical ulnar fracture associated with long-term bisphosphonate use.
        J Orthop Sci. 2015 Nov; 20: 1132-1135
        • Shimada Y.
        • Ishikawa T.
        • Endo J.
        • Katsuragi J.
        • Kotani T.
        • Kiuchi H.
        • et al.
        Treatment of atypical ulnar fractures associated with long-term bisphosphonate therapy for osteoporosis: autogenous bone graft with internal fixation.
        Case Rep Orthop. 2017 Nov; 20178602573https://doi.org/10.1155/2017/8602573
        • Oh B.H.
        • Heo Y.M.
        • Yi J.W.
        • Kim T.G.
        • Lee J.S.
        Atypical fracture of the proximal shaft of the ulna associated with prolonged bisphosphonate therapy.
        Clin Orthop Surg. 2018 Sep; 10: 389-392
        • Donnelly E.
        • Meredith D.S.
        • Nguyen J.T.
        • Gladnick B.P.
        • Rebolledo B.J.
        • Shaffer A.D.
        • et al.
        Reduced cortical bone compositional heterogeneity with bisphosphonate treatment in postmenopausal women with intertrochanteric and subtrochanteric fractures.
        J Bone Miner Res. 2012 Mar; 27: 672-678
        • Koh J.S.
        • Goh S.K.
        • Png M.A.
        • Ng A.C.
        • Howe T.S.
        Distribution of atypical fractures and cortical stress lesions in the femur: implications on pathophysiology.
        Singap Med J. 2011 Feb; 52: 77-80
        • Shane E.
        • Burr D.
        • Abrahamsen B.
        • Adler R.A.
        • Brown T.D.
        • Cheung A.M.
        • 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 Jan; 29: 1-23
        • Hreha J.
        • Congiusta D.V.
        • Ahmed I.H.
        • Vosbikian M.M.
        What is the normal ulnar bow in adult patients?.
        Clin Orthop Relat Res. 2020 Jan; 478: 136-141
        • Tubbs R.S.
        • O'Neil Jr., J.T.
        • Key C.D.
        • Zarzour J.G.
        • Fulghum S.B.
        • Kim E.J.
        • et al.
        The oblique cord of the forearm in man.
        Clin Anat. 2007 May; 20: 411-415
        • Kapandji I.A.
        The physiology of the joints: the upper limb.
        one. Churchill Livingstone, 2007 Jan: 112-115
        • Fujita M.
        An anatomical study on the interosseous membrane of the forearm.
        Nihon seikei geka gakkai zasshi. 1995 Oct; 69: 938-950
        • Hackl M.
        • Bercher M.
        • Wegmann K.
        • Müller L.P.
        • Dargel J.
        Functional anatomy of the lateral collateral ligament of the elbow.
        Arch Orthop Trauma Surg. 2016 Jul; 136: 1031-1037