Pertrochanteric Fractures of Femur: Does the Osteoporotic Treatment Effects the Fracture Pattern

Yaacobi Eyal 1 Pnina Roitman 2 Michael Tamar 1 Binyamin Kish 1 Meir Nyska 1 Yaron Brin 1
1Orthopedic Surgery, Meir Medical Center, Kfar Saba, Israel
2Endocrinology, Endocrinology - Bone Metabolic Clinic, Kfar Saba, Israel

Background: The incidence of fragility hip fracture is increasing worldwide. Most acceptable and used classifications separate the fractures around the hip to intracapsular and extracapsular fractures. They are further classified according to stability. It has been shown in previous studies that there`s a shift of prevalence from stable fracture pattern to an unstable in the last decade.

Hypothesis: The objective of this study is to check if the increase popularity of treatment of osteoporosis with anti absorbent drugs (esp. bisphosphonates) can provide an explanation for this shift in fracture pattern.

Methods: Between 2013 - 2014, 370 patients with fragility hip fracture concluded in this study. They were divided into 3 groups: group 1 had stable extracapsular fracture (AO A1.1-A2.1),group 2 had unstable extracapsular fracture (AO A2.2-A3.2) and group 3 with intracapsular fracture (AO B, subcapital fractures). they were compared according to the osteoporotic treatments, specifically to bisphosphonate (BP) treatment. vitamin D & calcium supplement, years of treatment and previous fractures. Also data on vitamin D levels was collected.

Results: Out of the 370 patients concluded in this study, 88 had previous treatment with bisphosphonates and 286 didn’t receive any treatment for osteoporosis. in group 1 18.3% had previous treatment with BP compared to 38.3% in group 2. In group 3 only 13.8% of patients had previous treatment with BP. Comparing groups 1 & 2 had statistical significant of P<0.001

Conclusion: In patients with previous treatment of BP there were 3 times more unstable fractures than stable. the effect of bisphosphonates treatment on intracapsular fracture was obvious.

It`s our believe that the effect of bisphosphonates on the bone, changes its elastic properties which in turn effect the pattern of the fracture. We probably need larger groups in order to confirm this hypothesis.