Knowledge Gap among General Practitioners, Endocrinologists and Orthopedic Surgeons Regarding Atypical Lesions and Fractures of the Femur due to Long Term Use of Bisphosphonates


Eran Keltz Igor Doronov Yaniv Keren
Orthopaedic Surgery, Rambam Health Care Campus, Haifa, Israel

Background: Bisphosphonates prevent clinical fractures in women younger than 80 years of age with documented osteoporosis. However adverse events related to these agents may affect the patients. There is a strong association between long term use of bisphosphonates and occurrence of atypical femoral lesions and fractures. Our study investigates the awareness level of community physicians for early recognition and prevention of atypical femoral hip fractures in osteoporotic patients treated with bisphosphonates in three groups of physicians: General physicians, orthopedic surgeons and endocrinologists.

Aim: The aim of this study is to examine the awareness level in these three groups and to suggest acts for early recognition and prevention of atypical hip fractures in patients using bisphosphonates.

Methods: General physicians, orthopedic surgeons and endocrinologists were asked to anonymously fill a questionnaire checking their common knowledge regarding side effects associated with long term use of bisphophonates, optimal duration of treatment with bisphosphonates, recognition of atypical lesions or fractures, and prevention of further fractures.

Results. The study involved 165 participants. The highest level of awareness level was detected in the group of endocrinologists. On the other hand, lowest rates of awareness to clinical aspects, treatment options as well as ways of prevention of atypical fractures were found in the group of general physicians. In the orthopedic surgeons group some aspects of long term use of bisphophonates and atypical fractures were found to be poor.

Conclusions: There is an obvious need to raise the awareness about the possibility of atypical hip lesions and fractures in patients treated with bisphosphonates which could lead to early diagnosis of atypical femoral lesions and prevention of subsequent fractures.