Surgical Treatment Improves Clinical and Functional Outcomes for Patients Who Sustain Incomplete Bisphosphonate-Related Femur Fractures

Objective: To describe the outcomes for patients treated at a single institution, who sustained incomplete bisphosphonate-induced femoral fractures. Design: Retrospective review. Setting: University-based academic medical center. Patients: Thirty-one patients with 43 incomplete fractures met the inclusion criteria. Intervention: Nonoperative management or surgical intervention for fractures with refractory symptoms or progression of fracture lucency on radiographs. Main Outcome Measurements: Radiographic assessments and the Short Musculoskeletal Functional Assessment to gauge functional status. Results: The cohort was all women with an average age of 69.2 (range: 46-92) years and had been treated with bisphosphonate therapy for an average of 9.1 (range: 5-20) years. The average healing time for all incomplete fractures was 9.4 (range: 1.5-36) months. Forty-nine percent of the fractures (21 of 43 fractures) were ultimately treated with surgery for impending complete fracture or failure of nonsurgical management. Of the incomplete fractures treated with surgery, 81% became pain free and 100% were radiographically healed at a mean of 7.1 (range: 1.5-12) months. In contrast, of the nonoperatively treated incomplete fractures, only 64% were pain free at latest follow-up, with only 18% of fractures demonstrating radiographic evidence of healing at an average of 11 (range: 6-24) months. Standardized dysfunction index from the Short Musculoskeletal Functional Assessment was better (19.7) in the surgical group than in the nonsurgical group (19.7 vs. 25.7, P = 0.0017). Conclusions: A higher percentage of patients treated surgically became asymptomatic and demonstrated radiographic evidence of healing earlier than those treated nonsurgically. Surgical intervention is effective for relief of symptoms when treating incomplete bisphosphonate-related femur fractures, and patients should be counseled to the potential benefits of prophylactic surgery.