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Spontaneous Fractures (Pathological Fracture)

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Fractures occurring as a result of disease of a bone or from some undiscoverable cause, and not due to trauma. (Dorland, 27th ed)

Also Known As:

Pathological Fracture; Pathologic Fracture; Spontaneous Fracture; Fractures, Spontaneous; Fracture, Pathologic; Fracture, Pathological; Fractures, Pathologic; Pathological Fractures; Fracture, Spontaneous; Pathologic Fractures; Fractures, Pathological

Networked: 946 relevant articles (36 outcomes, 45 trials/studies)

Relationship Network

Disease Context: Research Results

Wounds and Injuries: 94065
- Bone Fractures: 1763
  - Spontaneous Fractures: 946

Related Diseases

1.	Pain (Aches)
2.	Spinal Cord Compression
3.	Neoplasm Metastasis (Metastasis)
4.	Hypercalcemia (Milk Alkali Syndrome)
5.	Multiple Myeloma

Experts

1.	Lipton, Allan: 7 articles (10/2010 - 09/2004)
2.	Donneys, Alexis: 5 articles (09/2015 - 04/2012)
3.	Buchman, Steven R: 5 articles (09/2015 - 04/2012)
4.	Deshpande, Sagar S: 5 articles (09/2015 - 04/2012)
5.	Tchanque-Fossuo, Catherine N: 5 articles (09/2015 - 04/2012)
6.	Saad, Fred: 5 articles (04/2008 - 12/2002)
7.	Rief, Harald: 4 articles (01/2015 - 01/2013)
8.	Bruckner, Thomas: 4 articles (01/2015 - 01/2013)
9.	Terpos, Evangelos: 4 articles (02/2014 - 01/2003)
10.	Mavrogenis, Andreas F: 4 articles (06/2012 - 01/2007)

Drugs and Biologics

Drugs and Important Biological Agents (IBA) related to Spontaneous Fractures:

1.	DiphosphonatesIBA 03/01/2015 - "Despite this, the benefits of bisphosphonates outweigh the risks, because far more pathologic fractures are prevented than induced. " 05/01/2011 - "A majority of the patients underwent various minor or major surgical procedures and seven patients received bisphosphonates for recurrent pathological fractures. " 02/01/2009 - "Preliminary research observations indicate that spontaneous fracture may be a rare adverse outcome associated with bisphosphonates." 01/01/2007 - "Bisphosphonates are used to prevent pathological fractures by inhibition of osteoclasts. " 08/01/1998 - "Pathological fracture of the mandible treated with diphosphonates."
2.	zoledronic acid (zoledronate)FDA Link 12/01/2002 - "In a large phase III randomized trial, zoledronic acid 4 mg every 3 weeks for 15 months significantly reduced the percentage of men who experienced a skeletal complication and reduced the incidence of pathologic fractures. " 11/01/2015 - "This case illustrated the benefit of zoledronate treatment in patients with extensive polyostotic FD and pathological fractures of extremities. " 04/01/2008 - "Furthermore, zoledronic acid reduced the incidence of pathologic fracture, a skeletal-related event known to be associated with reduced survival. " 10/15/2007 - "Data from randomized, controlled trials of zoledronic acid were retrospectively analyzed to assess the effect of pathologic fractures on survival in patients with malignant bone disease. " 03/01/2008 - "Aminobisphosphonates (NBPs) such as zoledronate induce osteoclast apoptosis and thereby decrease malignant skeletal destruction, severity of bone pain, and frequency of pathologic fracture. "
3.	Clodronic Acid (Clodronate)IBA 01/01/1991 - "In a long-term (18 months) placebo-controlled study we have shown that clodronate, given orally at a daily dose of 1.6g, can decrease both the incidence of pathological fractures and the activity of osteoclasts, as judged by measurements in iliac crest biopsy. " 06/01/1999 - "[Pathological fracture of the mandible: a report of a clinical case treated with clodronate]." 03/01/1993 - "All together, 12 pathologic fractures occurred in five clodronate-treated patients, whereas in the control group 23 pathologic fractures occurred in the same number of patients during the whole observation period. " 01/01/1991 - "Recent studies have shown that clodronate is effective in the treatment of malignancy hypercalcaemia, relief of bone pain and decreases the risk of pathological fracture. " 01/01/1991 - "As regards the clinical evolution, negative events such as the appearance of hypercalcemia, pathological fractures, new bone lesions or a substantial increase in the preexisting ones, were observed in 9 of the 12 evaluable patients treated with placebo and in 3 out of 9 treated with CL2MDP. "
4.	pamidronate (APD)FDA LinkGeneric 03/01/2005 - "Pamidronate caused a first exposure transient flu-like illness lasting <24 h in three patients and one patient had a new pathological fracture. " 03/01/2005 - "Children with symptomatic pathological fractures of the axial spine or ribs were treated with pamidronate 1 mg/kg/dose (n=17) IV at 60-day intervals for 1 yr (n=15) or 2 yr (n=2). " 01/01/2000 - "The analysis is most sensitive to the costs of pamidronate and pathologic fractures that were asymptomatic or treated conservatively." 09/01/1998 - "Of 29 surviving patients with bone mineral density <0.84 g/cm2 before transplantation, 38% who did not receive treatment with pamidronate suffered spontaneous fracture, whereas 0 of 13 who received treatment suffered such a complication. " 10/31/1987 - "There was a significant reduction in pathological fractures and severe bone pain in the APD group, and hypercalcaemia was prevented. "
5.	Methylmethacrylate (Metaplex)IBA 09/01/1982 - "This study appears to clearly indicate that methylmethacrylate enhances the stability of the pathological fracture and contributes to achieving the goals of treatment in these severely compromised patients." 01/01/1976 - "Pathologic fractures of femoral shaft: study of internal fixation techniques incorporating methylmethacrylate." 01/01/1988 - "From this series, we conclude that any patient who has a pathologic fracture or impending fracture of the humerus and a predicted survival of six weeks or more is likely to benefit from rigid internal fixation with an appropriately selected device, adjunctive use of methylmethacrylate, and postoperative local irradiation therapy as needed." 09/01/1984 - "Internal fixation, supplemented with methylmethacrylate to fill bone defects, is the standard treatment for pathologic fractures. " 09/01/1982 - "Subtrochanteric pathological fractures should be internally fixed using a Zickel nail and methylmethacrylate. "
6.	Prednisone (Sone)FDA LinkGeneric 12/01/2010 - "This study verified that the alterations in the bone metabolism of the dogs submitted to the therapy with prednisone in a dosage of 2 mg/kg occur rapidly, which recommends a monitoring of the patients for the prevention of pathologic fractures." 05/01/1996 - "In 17 patients treated with prednisone, pathologic fractures developed, which involved the hips and the spine. " 03/01/1988 - "The mean age of the patients was 52 years, the average years of prednisone therapy was 5.3, and the mean dose of alternate day prednisone was 26.2 mg. In this group of 85 patients the prevalence of hypertension, peptic ulcer disease, pathologic fractures and psychosis was not statistically increased over that of the general population. " 09/01/2003 - "The dog improved clinically after initiation of chemotherapy with melphalan and prednisone; however, the dog ultimately was euthanatized because of pathologic fracture. " 08/01/2012 - "The search for evidence was based on real clinical scenarios, and used the following keywords (MeSH terms): Osteoporosis, Osteoporosis/ chemically induced*= (Glucocorticoids= Adrenal Cortex Hormones, Steroids), Glucocorticoids, Glucocorticoids/administration and dosage, Glucocorticoids/therapeutic use, Glucocorticoids/adverse effects, Prednisone/adverse effects, Dose-Response Relationship, Drug, Bone Density/drug effects, Bone Density Conservation Agents/pharmacological action, Osteoporosis/prevention & control, Calcium, Vitamin D, Vitamin D deficiency, Calcitriol, Receptors, Calcitriol; 1-hydroxycholecalciferol, Hydroxycholecalciferols, 25-Hydroxyvitamin D3 1-alpha-hydroxylase OR Steroid Hydroxylases, Prevention and Control, Spinal fractures/prevention & control, Fractures, Spontaneous, Lumbar Vertebrae/injuries, Lifestyle, Alcohol Drinking, Smoking OR tobacco use disorder, Movement, Resistance Training, Exercise Therapy, Bone density OR Bone and Bones, Dual-Energy X-Ray Absorptiometry OR Absorptiometry Photon OR DXA, Densitometry, Radiography, (Diphosphonates Alendronate OR Risedronate Pamidronate OR propanolamines OR Ibandronate OR Zoledronic acid, Teriparatide OR PTH 1-34, Men AND premenopause, pregnancy, pregnancy outcome maternal, fetus, lactation, breast-feeding, teratogens, Children (6-12 years), adolescence (13-18 years). "
7.	Analgesics (Analgesic Drugs)IBA 10/30/2005 - "The effect of reconstruction, besides fair or good outcome, included improved quality of life, less consumption of analgesics, and in many cases successful avoidance of pathological fracture." 02/01/2006 - "When the patients with pathologic fractures were separated out, the reduction in ingestion of analgesics was significant (P < 0.0008). " 05/01/2006 - "The consequences include pain which is refractory to conventional analgesics, osteolysis often leading to bone-marrow compression and pathological fractures, and metabolic disorders. " 11/01/2015 - "Radiotherapy can provide remarkable pain relief, reduce the requirement for analgesic drugs, and prevent pathological fracture or spinal cord compression with few complications in most patients. " 01/01/1985 - "Bone pain unmanageable with analgesics and pathologic fractures are the most common indications, while neurologic symptoms, hypercalcemia and congestive heart failure are less frequent ones. "
8.	Melphalan (Alkeran)FDA LinkGeneric 03/01/2014 - "Presence of bone pain and anemia in elderly patients should alert the clinician to investigate along the lines of MM. Majority of patients have osteolytic lesions on X-ray and pathological fractures, and benefit from melphalan based combinations in situations where facilities for transplant are not available." 09/01/2003 - "The dog improved clinically after initiation of chemotherapy with melphalan and prednisone; however, the dog ultimately was euthanatized because of pathologic fracture. " 03/25/1981 - "She was treated with discontinuous courses of melphalan and methyl-prednisolone, and developed a reversible nephrotic syndrome and a pathological fracture of the right clavicle. "
9.	Calcifediol (Calcidiol)FDA Link 01/01/1988 - "This article sets two bedridden mental retarded clinical cases, under a long run anticonvulsive treatment, who suffered from an osteomalacia syndrome, concealed until spontaneous fractures occurred and cured by a calcifediol treatment. " 10/01/1982 - "Low plasma calcitriol (1,25-dihydroxycholecalciferol) and normal serum calcifediol (25-hydroxycholecalciferol) levels were noted during the evaluation of an 11-year-old girl with diffuse osteoporosis and pathologic fractures. " 01/01/2013 - "Because of the clinical significance of autonomic dysreflexia and orthostatic hypotension, baseline BP and HR need to be routinely assessed in youth with SCI. In view of the high prevalence of vitamin D insufficiency in youth with SCI and the risk of complications such as pathological fractures, serum 25-hydroxycholecalciferol levels should be routinely monitored."
10.	A-factor (Streptomyces)IBA 03/01/1995 - "To serve as a basis for improved guidelines, a factor of risk for a pathologic fracture is defined as the load applied to a bone divided by the load at which the bone fails. " 10/01/2010 - "The mortality risk for patients with pathological fractures was significantly increased by a factor of 1.82 (p = 0.015), and overall duration of survival was significantly lower in the fracture group, with a median of 6.2 years (p < 0.00001). " 01/01/2001 - "A high proportion of stage IV disease and pathological fractures at presentation may be a factor." 03/01/1995 - "By combining new methods to predict the load-bearing capacity with estimated loads for activities of daily living, it is possible to calculate a factor of risk for pathologic fractures."

Therapies and Procedures

1.	Radiotherapy 11/01/2014 - "Despite the fact that the pathological fracture rate is 3.75 times higher in the single-fraction group, this schedule is considered more convenient for patients and more cost-effective for radiotherapy departments." 11/01/1988 - "The device also proved effective in four patients with pathological fractures, the closed insertion allowing the benefit of early radiotherapy. " 03/15/2010 - "The study group included 22 patients who developed a radiation-related pathological fracture of the femur after surgery and radiotherapy for an STS of the thigh. " 08/01/2007 - "Elevated BAP levels were also consistently associated with adverse skeletal outcomes on multivariate analyses of the time to radiotherapy and pathologic fracture, the most common types of skeletal-related events in the study population. " 09/01/2015 - "Radiotherapy (XRT) exerts detrimental collateral effects on bone tissue through mechanisms of vascular damage and impediments to osteocytes, ultimately predisposing patients to the debilitating problems of late pathologic fractures and nonunions. "
2.	Drug Therapy (Chemotherapy) 11/01/2013 - "Such novel discoveries establish the true potential to utilize pharmacotherapy to prevent and improve the treatment outcomes of radiation-induced late pathologic fractures." 09/01/2013 - "However, given the patient's dental and medical history, and the presence of multiple osteolytic lesions, the final diagnosis was MM. The patient underwent chemotherapy for the MM. To treat the pathological fracture of the jaw, a hemimandibulectomy was followed by the installation of a reconstructive plate. " 10/01/2012 - "Doctors should be aware of the possibility of major bone loss after chemotherapy with a risk of pathologic fracture. " 08/01/2012 - "Furthermore, she developed a pathological fracture during chemotherapy. " 05/01/2012 - "Immobilization and systemic chemotherapy with close observation are adequate for the management of patients despite the unstable pathological fracture of the odontoid process."
3.	Intramedullary Fracture Fixation 06/01/1996 - "Since the new method of osteosynthesis called "elastic stable intramedullary nailing" (ESIN) or "embrochage centro-medullaire elastique stable" (ECMES) has demonstrated the best results in the treatment of normal fractures in childhood, this method is rapidly being used in the treatment of spontaneous or pathological fractures. " 04/01/2011 - "This is a retrospective control study of 21 patients who underwent cemented intramedullary nailing for pathological fractures in the humeral shaft between 2005 and 2009 as compared to a historical control group of 19 patients that underwent locked intramedullary nailing for pathological fractures in the humeral shaft between 1999 and 2004. " 09/01/1982 - "An experimental model was developed to study the effects of a pathologic fracture and intramedullary nailing on metastatic spread. " 04/01/2015 - "Intramedullary nailing is the accepted form of treatment for impending or pathologic fractures of the femoral diaphysis. " 01/01/2015 - "CONCLUSION Intramedullary nailing represents a valuable fixation method for pathologic fractures or impending fractures of the femur in patients with an advanced stage of metastatic disease. "
4.	Osteotomy 04/01/2013 - "The purpose of this study was to analyse and compare right angled and curved osteotomy design on stress distribution and to determine an osteotomy design which decreases the risk of pathologic fracture. " 10/01/2013 - "Two-point osteotomy fracture strain gauge analysis demonstrated that the threshold of tibia corticotomy that would lead to pathologic fracture of the remaining tibia was greater than 30 percent. " 12/01/1988 - "Thirty-nine of the nails had been inserted in a fresh fracture, which usually was comminuted; eight had been used for fixation of an osteotomy; nine, for fixation of a non-union; and four, for treatment of a pathological fracture. " 08/01/1983 - "A reverse sagittal split osteotomy of the mandible for advancement or retraction of the mandible is described to be used in selected instances when the transoral modified sagittal ramus osteotomy would probably result in a pathologic fracture or an inadequate proximal segment. " 03/01/1978 - "Osteotomies through standardized cortical defects were created in intact embalmed femora to simulate a standard pathologic fracture. "
5.	Curettage 03/01/2010 - "In patients who have poor survival prognoses or are poor candidates for extensive reconstructive procedures, management with intralesional curettage and stabilization with bone cement with or without internal fixation to prevent development or propagation of a pathologic fracture may be the best option. " 11/01/2015 - "The presence of a pathological fracture should not preclude the decision to perform curettage as carefully selected patients who undergo curettage can have similar outcomes in terms of local recurrence to those without such a fracture. " 11/01/2015 - "We also assessed if curettage is still an appropriate form of treatment in the presence of a pathological fracture. " 11/01/2014 - "No complications occurred after ablation, while two patients developed a pathological fracture after curettage. " 10/05/2014 - "Thirty-six year old male patient with pathological fracture of the left tibia underwent intramedullary and soft tissue curettage. "