Physical Medicine & Rehabilitation Doctor; Ph.D. in Neuropharmacology & Cell Biology
I have spoken many times about the brittle 'glass' bones of biphosphonate drugs. Yet doctors continue to prescribe them instead of using D, A, and K2 together with gonadal hormones Estradiol, progesterone, testosterone and DHEA which serve to catalyze the entire process. I discussed the biochemistry in Preparing the Soil.
Chief of Trauma - The CORE Institute; Orthopaedic Trauma & Upper Extremity Surgeon; Associate Professor - University of Arizona College of Medicine Phoenix
Atypical femur fracture (from bisphosphonte use) These need to be correctly diagnosed, and properly fixed. This is an 80 year old with a proximal femur fracture. You can see that it's a classic atypical fracture: cortical thickening at the fracture site, cortical beaking, short transverse nature of the fracture. It's a bit lower than the usual subtorch location, but they can occur lower. These are important to diagnose, which changes management. So get a good history. If you ask the patient, they typically have symptoms for months before the fracture. They also usually say they felt their femur break (usually from twisting or minimal trauma), and then they fell down. That's a very common story: "I was in the kitchen, turned around, felt my leg snap and fell down". Always ask about bisphosphonate use. Even if they deny it, if you see this xray they are likely taking the medication and don't know about it (I've had that many times). Important things about these atypical fractures: 1) They take a long time to heal, since the both is pathologic, and have a high rate of delayed union and nonunion. 2) Given the high risk of delayed/nonunion you need to get a good reduction (as anatomic as you can). So open them if you have to, and no varus. See below for reduction info. 3) Always ask the patient about symptoms on the other side, and x-ray the other femur. This lady had some symptoms on the other femur, and xrays showed cortical beaking. She had the other side fixed prophylactically a few days later (same hospital stay) 4) Bisphosphonates need to be stopped, and refer the patient to a bone health specialist. How do you reduce them? This was done on a fracture table. (My personal preference is supine on fracture table, but some people go lateral or supine with no traction, either is fine). You can see that traction helps, but it's still malreduced. I usually push on the fracture with my fist to see how that helps to get an idea of how easy it will be to reduce. I thought this may go closed, but we were prepared to open. Once draped I tried to reduce it closed with pushing on it with a mallet, but it was completely displaced laterally. You can try to play around with it to get it closed, but I just made a small incision to open and clamp it. It makes it much easier and quicker to get the reduction that way. Remember you need to reduce these as perfect as you can! #orthotrauma #femur #fracture #orthopaedics #bisphosphonates
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It's interesting to consider alternative approaches to addressing bone health. Can you elaborate on the potential benefits of combining D, A, and K2 with gonadal hormones, and how this approach might compare to traditional biphosphonate treatments in terms of efficacy and safety?
Chief Medical Officer & Co-Founder at HIA Technologies and RetractOrtho | Former Academic Surgeon | Inventor & Patent Owner
2moNice pearls. Looks like the lateral cortex is incarcerated in the muscle/fascia and maybe why it did not reduce closed easily. Do you code the contractual as an impending pathological fracture?