Abstract #1408105: Treatment of Bisphosphonate Associated Atypical Femur Fracture with a Combination of Teriparatide and a Novel Surgical Technique

Atypical femur fractures (AFF) caused by long term Bisphosphonate use are associated with high rates of delayed healing and non-union, posing a significant challenge in the management these patients. We describe case 64-year-old female osteopenia on therapy for 15 years who sustained displaced left AFF following fall from standing height. She reported 6-month history antecedent groin pain. Radiographs showed an acute transverse diaphyseal fracture lateral cortical thickening beaking. The right radiograph features abnormal remodeling thickened, irregular cortices. DEXA T-scores -2.1 at femoral neck, -1.4 total hip, lumbar spine. underwent open reduction internal fixation insertion cephalomedullary nail placed compression mode. A novel technique intraoperative removal endosteal hypertrophied bone Midas rex cutting burr was used there excellent contact after reduction. had immediate relief her pain permitted to fully weight-bear postoperatively. Her bisphosphonate stopped immediately Teriparatide initiated 7 weeks post-operatively. 8 initiation evidence normal union mature callus formation. prolonged have rate non-union due remodeling. Use post-operatively has been shown reduce time recent small studies surgically treated Our demonstrates expedited when combined surgical involving portion end placement intramedullary Furthermore, patient radiographic femur, increasing risk contralateral AFF. Prophylactic stabilization recommended but deferred this. remains fracture-free pain-free side, suggesting possible benefit patients impending (3.5 months) relative previously average times (10.7 months), supporting combination technique.