¿Tardan más en consolidar las fracturas asociadas a bifosfonatos? [Is the time for consolidation of fractures associated with bisphosphonates higher?]

Contenido principal del artículo

Fernando Vanoli
Luciano Gentile
Alejandra Beatriz Juarez
Marcos Sahid Eluani
Ignacio Pioli
Bartolomé Luis Allende

Resumen

Introducción: Los bifosfonatos evolucionaron como el pilar para el tratamiento de la osteoporosis, reduciendo la incidencia de fracturas. Recientemente, varias publicaciones describieron la aparición de fracturas atípicas de fémur de baja energía asociadas con el uso de bifosfonatos. El objetivo de este estudio fue evaluar el tiempo promedio de consolidación de las fracturas atípicas de fémur asociadas al tratamiento con bifosfonatos comparado con el de un grupo de control. Materiales y Métodos: Se evaluó, en forma retrospectiva, a 34 mujeres (edad promedio 74 años) con fracturas atípicas; 16 de ellas habían recibido bifosfonatos, al menos, por cinco años. Fueron tratadas entre 2006 y 2017, y estabilizadas con un clavo cefalomedular. Este grupo fue comparado con un grupo de control de similares características. Resultados: Veintidós tenían fracturas subtrocantéricas y 12, diafisarias. El 14% de las que tomaron bifosfonatos y fueron operadas requirió una revisión frente al 5,5% del grupo de control. El tiempo promedio de consolidación fue mayor en las tratadas con bifosfonatos (8.5 vs. 6 meses), con una diferencia estadísticamente significativa (p <0,001).Conclusiones: El beneficio del tratamiento con bifosfonatos en la prevención de fracturas es superior al riesgo de fracturas atípicas; sin embargo, es importante evaluar la relación riesgo-beneficio en cada paciente al comienzo y durante el tratamiento, teniendo en cuenta que, pese a esto, el tiempo de curación es más largo. AbstractIntroduction: Bisphosphonates evolved as the mainstay for the treatment of osteoporosis, reducing the incidence of fractures. Recently, several publications described the occurrence of low-energy atypical femur fractures associated with the use of bisphosphonates. The objective of this work was to study the average time of consolidation of the atypical femoral fractures caused by the consumption of bisphosphonates compared with a control group.Materials and Methods: We retrospectively evaluated 34 patients with atypical femoral fractures of which 16 patients had undergone treatment with bisphosphonates for at least 5 years, treated between 2006 and 2017, and stabilized with a cephalomedullary nail, and were compared with a control group of similar characteristics.Results: All the patients were female. The average age was 74 years. 22 presented subtrochanteric fractures while 12 were diaphyseal. 14% of the subjects who took bisphosphonates and received surgical treatment, required a revision versus 5.5% of the control group. The average time of consolidation was higher in those treated with bisphosphonates (8.5 months vs. 6 months), this being statistically significant (p <0.001).Conclusions: The benefit of treatment with bisphosphonates in the prevention of fractures is greater than the risk of atypical fractures. However, it is important to evaluate the risk-benefit in each patient at the beginning and the duration of the treatment, taking into account that despite this, the healing time is longer.   

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Vanoli, F., Gentile, L., Juarez, A. B., Eluani, M. S., Pioli, I., & Allende, B. L. (2019). ¿Tardan más en consolidar las fracturas asociadas a bifosfonatos? [Is the time for consolidation of fractures associated with bisphosphonates higher?]. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 84(4), 320-327. https://doi.org/10.15417/issn.1852-7434.2019.84.4.917
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Investigación Clínica
Biografía del autor/a

Fernando Vanoli, SANATORIO ALLENDE, Córdoba, Argentina

Médico del Servicio de Traumatología y Ortopedia del Sanatorio Allende, Córdoba, Argentina

Luciano Gentile, Sanatorio Allende, Córdoba, Argentina

Médico del Servicio de Traumatología y Ortopedia del Sanatorio Allende, Córdoba, Argentina

Alejandra Beatriz Juarez, Sanatorio Allende, Córdoba, Argentina.

Residente de traumatología del Sanatorio Allende, Córdoba, Argentina

Marcos Sahid Eluani, Sanatorio Allende, Córdoba, Argentina

Residente de Traumatologia y Ortopedia del Sanatorio Allende, Córdoba, Argentina

Ignacio Pioli, Sanatorio Allende, Córdoba, Argentina

Médico del Servicio de Traumatología y Ortopedia del Sanatorio Allende, Córdoba, Argentina

Bartolomé Luis Allende, Sanatorio Allende, Córdoba, Argentina

Médico del Servicio de Traumatología y Ortopedia del Sanatorio Allende, Córdoba, Argentina

Citas

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