Atypical femoral fractures: epidemiology, etiology, and patient management.
Atypical femoral fractures: epidemiology, etiology, and patient management.
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DOI：
10.1097/spc.0b013e3283552d7d
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发表时间：
2012-09
影响因子：
2.1
通讯作者：
Lane JM
中科院分区：
文献类型：
--
作者：
Donnelly E;Saleh A;Unnanuntana A;Lane JM
回顾非典型股骨骨折的定义、流行病学和假定的病理生理学，并提出非典型骨折患者以及长期服用双磷酸盐但无非典型骨折患者的治疗策略。最近的流行病学证据表明，与典型髋部骨折的发生率相比，非典型股骨骨折的绝对发生率较小。然而，长期使用双膦酸盐可能是非典型骨折的一个重要危险因素，并且已证明对于绝经后骨质疏松症患者，治疗时间超过 5 年的额外抗骨折益处微乎其微。本综述为临床医生治疗初发或完全非典型骨折的患者提供了建议。关于如何最好地治疗非典型骨折患者的证据极其有限。对长期使用双磷酸盐的患者进行综合代谢方法的管理将有助于防止骨重塑的过度抑制，骨重塑与这些骨折的发病机制有关。
To review the definition, epidemiology, and putative pathophysiology of atypical femoral fractures and propose strategies for management of patients with atypical fractures as well as patients on long-term bisphosphonates without atypical fractures. Recent epidemiologic evidence shows that the absolute incidence of atypical femoral fractures is small compared to the incidence of typical hip fractures. However, long-term bisphosphonate use may be an important risk factor for atypical fractures, and minimal additional antifracture benefit has been demonstrated for treatment durations longer than 5 years for patients with postmenopausal osteoporosis. This review gives advice to aid clinicians in the management of patients with incipient or complete atypical fractures. Extremely limited evidence is available for how best to manage patients with atypical fractures. A comprehensive metabolic approach for management of patients on long-term bisphosphonates will help to prevent oversuppression of bone remodeling that is implicated in the pathogenesis of these fractures.