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Subtrochanteric and diaphyseal femoral fractures in hypophosphatasia-not atypical at all.
- Source :
-
Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA [Osteoporos Int] 2018 Aug; Vol. 29 (8), pp. 1815-1825. Date of Electronic Publication: 2018 May 17. - Publication Year :
- 2018
-
Abstract
- Risk for subtrochanteric and diaphyseal femoral fractures is considered increased in patients with hypophosphatasia (HPP). Evaluating a large cohort of HPP patients, we could for the first time quantify the prevalcence and identify both morphometric features as well as predisposing factors for this complication of severe HPP.<br />Introduction: Subtrochanteric and diaphyseal femoral fractures have been associated with both, long-term antiresorptive treatment and metabolic bone disorders, specifically Hypophosphatasia (HPP). Building on a cross-sectional evaluation of real-world data, this study reports risk factors, prevalence, treatment outcome and morphometric particularities for such fractures in HPP as compared to Atypical Femoral Fractures (AFF) in long-term antiresorptive treatment.<br />Methods: For 15 out of 150 HPP patients identified with having experienced at least one such fracture, medical records were reviewed in detail, extracting medical history, genotype, lab assessments, bone mineral density (DXA), radiographic data on femoral geometry and clinical aspects of fracture etiology and healing.<br />Results: Bilateral fractures were documented in 10 of these 15 patients, yielding a total of 25 fractures for evaluation. Disease-inherent risk factors included autosomal-recessive, childhood onset HPP, apparently low alkaline phosphatase (ALP) ≤ 20 U/l and substantially elevated pyridoxal 5'-phosphate (PLP) > 3 times upper limit of normal as well as high lumbar spine BMD. Fracture morphology met definition criteria for AFF in 88% of cases. Femoral geometry revealed additional risk factors previously described for AFF, including decreased femoral neck-shaft angle and increased femoral offset. Extrinsic risk factors include Hypovitaminosis D (80%) and pre-treatment with bisphosphonates (46,7%) and Proton-Pump Inhibitors (40%).<br />Conclusions: Increased risk for subtrochanteric and diaphyseal femoral fractures in HPP appears to result from both compromised bone metabolism as well as disease-associated bone deformities. In severe HPP, generous screening for such fractures seems advisable. Bisphosphonates and Hypovitaminosis D should be avoided. Healing is compromised and requires mindful consideration of both pharmacological and surgical options.
- Subjects :
- Adult
Aged
Bone Density physiology
Bone Density Conservation Agents adverse effects
Cross-Sectional Studies
Diphosphonates adverse effects
Female
Femoral Fractures diagnostic imaging
Femoral Fractures physiopathology
Femoral Fractures surgery
Fracture Fixation methods
Fractures, Spontaneous diagnostic imaging
Fractures, Spontaneous physiopathology
Fractures, Spontaneous surgery
Hip Fractures diagnostic imaging
Hip Fractures etiology
Hip Fractures physiopathology
Hip Fractures surgery
Humans
Hypophosphatasia physiopathology
Male
Middle Aged
Radiography
Risk Factors
Treatment Outcome
Femoral Fractures etiology
Fractures, Spontaneous etiology
Hypophosphatasia complications
Subjects
Details
- Language :
- English
- ISSN :
- 1433-2965
- Volume :
- 29
- Issue :
- 8
- Database :
- MEDLINE
- Journal :
- Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA
- Publication Type :
- Academic Journal
- Accession number :
- 29774402
- Full Text :
- https://doi.org/10.1007/s00198-018-4552-3