Evidence map›Paper›PMID 31497503›Full record

ReviewJournal of bone oncology2019

Atypical femoral fractures from bisphosphonate in cancer patients - Review.

Matthew Lockwood, Rajesh Banderudrappagari, Larry J Suva, Issam Makhoul

Open access · goldAbstract readReview
PubMed Full text at PMC Publisher
In one paragraph

Review in Journal of bone oncology, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 15 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
15citing papers in PubMed, 1 pooled it
1.4field-weighted citation impact, top 16% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

15 citing papers in PubMed, 1 synthesis or guideline pooled it, 30 citations in OpenAlex.

  1. Pooled it
  2. Trial
  3. Article
  4. Article
  5. Article
  6. Atypical Femur Fracture in a Teenager on Chronic Imatinib Therapy.Case reports in oncological medicine · 2025
    Article
  7. Latent metabolic bone disease, skeletal dysplasia and other conditions related to low bone formation among 38 patients with subtrochanteric femoral fractures: a retrospective observational study.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2024
    Observational
  8. Differences in bone histomorphometry between White postmenopausal women with and without atypical femoral fracture after long-term bisphosphonate therapy.Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research · 2024
    Article
  9. Factors Affecting the Second Complete Atypical Femoral Fracture after the First Atypical Fracture.Medical principles and practice : international journal of the Kuwait University, Health Science Centre · 2024
    Article
  10. Article
  11. Article
  12. Article
  13. Article
  14. Review
  15. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

4 authors at 2 institutions in 1 country.

Matthew LockwoodDivision of Hematology/Oncology, Department of Internal Medicine, University of Arkansas for Medical Sciences, 4301 West Markham, Little Rock, AR, 72205, USA.
Rajesh BanderudrappagariDivision of Hematology/Oncology, Department of Internal Medicine, University of Arkansas for Medical Sciences, 4301 West Markham, Little Rock, AR, 72205, USA.
Larry J SuvaDepartment of Veterinary Physiology and Pharmacology, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, 4466 TAMU, College Station, TX, 77843-4466, USA.
Issam MakhoulDivision of Hematology/Oncology, Department of Internal Medicine, University of Arkansas for Medical Sciences, 4301 West Markham, Little Rock, AR, 72205, USA.
University of Arkansas for Medical Sciences · USTexas A&M University · US

Funding

Breast Cancer Bone MetastasisR01CA166060 · NCI · UNIV OF ARKANSAS FOR MED SCIS · PI SUVA, LARRY J. · 2013 to 2017
$1.5M
NCI NIH HHS R01 CA166060
6 · The paper itself

Abstract

Bisphosphonates are commonly used in patients with metastatic bone disease to prevent skeletal related events. Atypical femur fracture is a known complication of long-term bisphosphonate use but the incidence in cancer patients and pathogenesis are not well known. Several mechanisms of pathogenesis have been proposed including altered angiogenesis, altered bone mechanical properties, micro damage and bone remodeling suppression. Atypical femur fractures are atraumatic or minimally traumatic fractures in the sub trochanteric region or the femoral shaft. Awareness of atypical femur fractures is critical to diagnose and treat them in a timely manner. There is a paucity of data regarding the management of atypical femur fracture in patients with malignancy. Management options of atypical femur fractures include stopping bisphosphonates, initiating calcium/vitamin D supplementation and either surgery with internal fixation or conservative management. In the future, it will be important to explore the effect of continuous vs. intermittent exposure, cumulative dose and length of exposure on the incidence of this complication. Herein, we review the epidemiology, risk factors, management options and proposed mechanisms of pathogenesis of atypical femur fractures.

Indexed as

AFF, atypical femur fractureAGE, advanced glycation end productsASBMR, American Society of Bone and Mineral ResearchAtypical femur fractureBisphosphonatesBone metastasisBone remodelingBP, bisphosphonateCI, confidence intervalCT, computed tomographyDenosumabGGPPS, geranyl geranyl pyrophosphate synthase Her2, human epidermal growth factor receptorIM, intramedullaryIV, intravenousMGUS, monoclonal gammopathy of unknown significanceMRI, magnetic resonance imagingONJ, osteonecrosis of the jawORIF, open reduction internal fixationOR, odds ratioRCT, randomized clinical trialVEGF, vascular endothelial growth factor

Identifiers

PMID31497503
PMCPMC6722257
OpenAlexW2969442875

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC-ND
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.