Abstract

SA, Lima e; DIAS, Rui  and  FONSECA, Fernando. Fraturas subtrocantéricas atípicas e tratamento prolongado com bifosfonatos. Rev. Port. Ortop. Traum. [online]. 2012, vol.20, n.3, pp.371-378. ISSN 1646-2122.

This article aims to review the scientifi c evidence of the association between long-term treatment with bisphosphonates and the risk of atypical subtrochanteric fractures as well as the presentation of a clinical case that supports this association. The atypical subtrochanteric fractures have an incidence of 2.3/10.000 inhabitants/year, and by defi nition originate from minor traumatic event or in the absence of trauma, with clinical features typical transverse linear mark in its radiographic appearance and high morbidity / mortality (25% at 2 years). The therapeutic effect of bisphosphonates in osteoporosis results from their anti-reabsorvita the bone, reducing the number of new osteoclasts, decreasing its activity and stimulating their apoptosis, with consequent reduction in bone turn-over. Strong and prolonged inhibition of resorption deregulates the normal bone turnover, inducing a process of bone remineralization, which increases the bone stiffness ("frozen bone") and leads to accumulation of microcracks which may progress to fatigue fractures. The existing scientific evidence and expose case can not unambiguously confi rm an increased risk of atypical subtrochanteric fractures as a result of prolonged use of bisphosphonates, although most of the publications suggest the use of more than 5 years of this class of anti-osteoporotic can lead to fatigue or atypical subtrochanteric fractures.

Keywords : Fractures; femur; subtrochanteric; atypical; biphosponates.

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