Atypical femoral fracture after receiving antiresorptive drugs in breast cancer patients with bone metastasis.
Atypical femoral fracture after receiving antiresorptive drugs in breast cancer patients with bone metastasis.
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DOI：
10.1007/s12282-016-0746-8
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发表时间：
2017-07
期刊：
影响因子：
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通讯作者：
Ishibashi Y
中科院分区：
文献类型：
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作者：
Ota S;Inoue R;Shiozaki T;Yamamoto Y;Hashimoto N;Takeda O;Yoshikawa K;Ito J;Ishibashi Y
非典型股骨骨折（AFF）发生在接受抗骨吸收药物（如双膦酸盐和地舒单抗）的患者中，伴有轻微创伤。我们假设接受高剂量抗骨吸收药物治疗的骨转移患者发生AFF的频率更高。本研究旨在调查接受抗骨吸收药物治疗的乳腺癌骨转移患者中AFF的患病率。基于我院的数据库，对2014年3月至9月期间的乳腺癌患者进行了调查。32例接受高剂量抗骨吸收药物治疗的骨转移患者被纳入分析，并被定义为转移（M）组。对照组（C）为同期未接受抗骨吸收药物治疗的乳腺癌无骨转移患者32例。我们评估了CT定位视图中外侧皮质（喙状）和股骨颈干角的局限性骨膜增厚，从抗吸收药物诱导到喙状出现的时间，以及完全骨折的发生率。对两组进行比较。M组32例患者64条肢体中，6例患者8条肢体在转子下区域出现喙状（12.5%）。喙状骨折发生后，3例患者的5条肢体最终完全骨折，创伤较小（7.8%）。另一方面，在C组中未观察到喙状突起。在接受双膦酸盐和/或地舒单抗治疗骨转移的乳腺癌患者中，AFF的发生率较高。对这些患者AFF的发生应比对肺结核患者更加重视。
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. 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. 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. 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.