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비전형적 대퇴골 골절

Atypical Subtrochanteric and Diaphyseal Femoral Fractures

송형근|양규현
대한골대사학회 (The Korean Society of Bone Metabolism)|2011.11|대한골대사학회지 (Journal of Bone Metabolism)|제18권 제2호|pp. 85-92

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골다공증Osteoporosis비스포스포네이트BisphosphonatesAtypical femoral fracture비전형 대퇴골 골절
주제분류정형외과학

초록

최근 인구의 고령화로 골다공증의 증가와 이에 대한 치료로 비스포스포네이트 제제의 이용이 증가하고 있다. 비스포스포네이트 제제는 골다공증의 예방과 치료에 있어서 매우 중요한 약제 중 하나이며 골다공증으로 인한 신생 골절을 1/2까지감소시킨다. 그러나 비스포스포네이트 제제의 장기 복용 환자 10,000명당 2.3명 정도에서 비전형 대퇴골 골절이 발생한다고 하는데, 이는 대부분 수평 혹은 짧은 사선 골절이며, 분쇄상이 없는 단순 골절이고 외측에서 시작하며 내측에 돌기 형성 등이 있는 특징이 있다. 부가 양상으로는 외측 피질골의 골막 반응, 전반적인 피질골의 비후, 골절 전증상 (대퇴부 통증), 지연 유합, 양측성 등을 들 수 있다. 비스포스포네이트 제제와 비전형적 대퇴골 골절의 연관성을 완전히 배제할 수없는 만큼 치료의 기간에 따른 위험도 평가와 정보 전달은 필수적이라 생각된다. 장기적으로 투약이 불가피한 환자에서는이중 에너지 방사선 흡수법을 이용한 골절 전 병변의 추적과 통증 발생 유무를 잘 관찰하여 조기 발견에 주의를 기울여야 할 것이다.

Abstract

Increasing numbers of atypical subtrochanteric fractures have been reported among long-term bisphosphonate users. However, the nature and extent of the problem are unknown despite recent investigations. The task force of American Society for Bone and Mineral Research (ASBMR) defined major and minor features of complete and incomplete atypical femoral fractures; transverse or short oblique orientation, minimal or no associated trauma, a medial spike when the fracture is complete, and absence of comminution. Minor features include their association with cortical thickening, a periosteal reaction of the lateral cortex, prodromal pain, bilaterality, delayed healing, comorbid conditions,and concomitant drug exposures, including bisphosphonate, glucocorticoids, and proton pump inhibitors. Based on published data, the incidence of atypical femoral fractures associated with bisphosphonate therapy for osteoporosis appears to be very low, particularly compared with the number of vertebral, hip, and other fractures that are prevented by bisphosphonate. Physicians and patients should be aware of the possibility of atypical femoral fractures and of the potential for bilaterality. [Korean Journal of Bone Metabolism, 18(2): 85-92, 2011]

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