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. 2017 Jul;24(4):601-607.
doi: 10.1007/s12282-016-0746-8. Epub 2016 Dec 10.

Atypical femoral fracture after receiving antiresorptive drugs in breast cancer patients with bone metastasis

Seiya Ota  1 , Ryo Inoue  2 , Takashi Shiozaki  2 , Yuji Yamamoto  2 , Naoki Hashimoto  3 , On Takeda  4 , Kei Yoshikawa  4 , Junji Ito  4 , Yasuyuki Ishibashi  2
Affiliations

Atypical femoral fracture after receiving antiresorptive drugs in breast cancer patients with bone metastasis

Seiya Ota et al. Breast Cancer. 2017 Jul.

Abstract

Background: Atypical femoral fracture (AFF) occurs with minor trauma in patients receiving antiresorptive drugs such as bisphosphonate and denosumab. We hypothesized that patients with bone metastasis who receive higher doses of antiresorptive drugs tend to experience AFF more frequently. This study aimed to investigate the prevalence rate of AFF in patients receiving antiresorptive drugs for bone metastasis of breast cancer.

Methods: Based on the database from our hospital, patients with breast cancer between March and September 2014 were investigated. Thirty-two patients with bone metastasis who received higher doses of antiresorptive drugs were included for analysis and defined as the metastasis (M) group. For the control (C) group, 32 patients in the same period with breast cancer without bone metastasis who did not undergo antiresorptive drug therapy were included. We evaluated the localized periosteal thickening of the lateral cortex (beaking) and femoral neck-shaft angle in CT scout view, the periods from induction of antiresorptive drugs to the appearance of beaking, and the occurrence rate of complete fracture. The 2 groups were compared.

Results: Of the 64 limbs in 32 patients of the M group, 8 limbs in 6 patients showed beaking at the subtrochanteric area (12.5%). After the occurrence of beaking, 5 limbs in 3 patients eventually had a complete fracture with minor trauma (7.8%). On the other hand, no beaking was observed in the C group.

Conclusions: The frequency of AFF in patients with breast cancer receiving bisphosphonate and/or denosumab for bone metastasis was high. More attention should be paid to the occurrence of AFF in these patients than osteoporotic patients.

Keywords: Atypical femoral fracture; Beaking; Bisphosphonate; Breast cancer; Denosumab.

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Conflict of interest statement

All authors have no conflicts of interest.

Figures

Fig. 1
Fig. 1
Beaking of lateral cortex in scout view of CT. The presence of localized periosteal or endosteal thickening of the lateral cortex at the subtrochanteric region (beaking) in CT scout view
Fig. 2
Fig. 2
Complete fracture of the bilateral femur by AFF. a Complete fracture of the right femur and beaking on the contralateral side. b Post open reduction and internal fixation of right femur. c Complete fracture of the left femur by AFF. d Post open reduction and internal fixation of the left femur
See this image and copyright information in PMC

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