AI Article Synopsis

  • - A study analyzed 38 patients with rare subtrochanteric femoral fractures to identify underlying metabolic bone diseases associated with low bone formation, revealing that 4 of them had such disorders.
  • - The research aimed to evaluate the prevalence of risk factors like age, glucocorticoid use, and antiresorptive agents among the patients, many of whom were older adults with a history of these medications.
  • - Key findings included that some patients were diagnosed with specific conditions like hypophosphatemic osteomalacia and a genetic variant linked to bone health, emphasizing the need for clinicians to investigate latent bone diseases in patients with atypical femoral fractures.

Article Abstract

Unlabelled: Subtrochanteric femoral fracture is rare and intractable due to the possible association with low bone formation. Retrospective analysis of 38 patients with subtrochanteric femoral fractures revealed that four patients suffered from disorders related to low bone formation and there were specific treatments for two of them.

Purpose: The main aim of this study was to detect latent metabolic bone diseases and skeletal dysplasia associated with low bone formation among patients with morphologic atypical femoral fracture (AFF). A second aim was to evaluate the frequency of recognized risk factors, such as antiresorptive agents, glucocorticoids, and age.

Methods: Clinical information was retrospectively analyzed among 38 Japanese patients who were admitted to the Department of Orthopedic Surgery and Spinal Surgery and the Division of Emergency and Critical Care Medicine at the University of Tokyo Hospital with diagnoses of subtrochanteric fractures between February 2012 and March 2022.

Results: Among 38 patients (including 30 females), 21 patients were aged 75 and over. Ten patients had past oral glucocorticoid use, and 18 had past antiresorptive agent use. Two patients were diagnosed with hypophosphatemic osteomalacia after the development of fractures. One patient was suspected to be a carrier of a loss-of-function variant of alkaline phosphatase, biomineralization associated (ALPL), and one other patient had previously been genetically diagnosed with pycnodysostosis. Among four patients with a diagnosis or suspicion of these metabolic bone diseases and skeletal dysplasia, four had past clinical fractures, two had past subtrochanteric femoral fractures, and two had subtrochanteric femoral fractures on both sides.

Conclusion: If clinicians encounter patients with morphologic AFF, latent diseases related to low bone formation should be carefully differentiated because appropriate treatment may prevent delayed union and recurrent fractures. Additionally, it may be desirable to exclude these bone diseases in advance before initiating long-term use of antiresorptive agents in osteoporotic patients by screening with serum alkaline phosphatase levels to reduce the risk of morphologic AFF.

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Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC11364693PMC
http://dx.doi.org/10.1007/s00198-024-07168-4DOI Listing

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