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Incidence, risk factors, and fracture healing of atypical femoral fractures: a multicenter case-control study

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Author(s)
S.-J. LimI. YeoP.-W. YoonJ.J. YooK.-H. RhyuS.-B. HanW.-S. LeeJ.-H. SongB.-W. MinY.-S. Park
Keimyung Author(s)
Min, Byung Woo
Department
Dept. of Orthopedic Surgery (정형외과학)
Journal Title
Osteoporosis International
Issued Date
2018
Volume
29
Issue
11
Keyword
Atypical femoral fractureBisphosphonatesFracture healingIncidenceRisk factors
Abstract
The incidence of atypical femoral fractures (AFFs) was 2.95% among 6644 hip and femoral fractures. Independent risk factors included the use of bisphosphonates (BPs), osteopenia or osteoporosis, rheumatoid arthritis, increased femoral curvatures, and thicker femoral cortices. Patients with AFFs and BP treatment were more likely to have problematic healing than those with typical femoral fractures (TFFs) and no BP treatment.

INTRODUCTION:

To determine the incidence and risk factors of atypical femoral fractures (AFFs), we performed a multicenter case-control study. We also investigated the effects of bisphosphonates (BPs) on AFF healing.

METHODS:

We retrospectively reviewed the medical records and radiographs of 6644 hip and femoral fractures of patients from eight tertiary referral hospitals. All the radiographs were reviewed to distinguish AFFs from TFFs. Univariate and multivariate logistic regression analyses were performed to identify risk factors, and interaction analyses were used to investigate the effects of BPs on fracture healing.

RESULTS:

The incidence of AFFs among 6644 hip and femoral fractures was 2.95% (90 subtrochanter and 106 femoral shaft fractures). All patients were females with a mean age of 72 years, and 75.5% were exposed to BPs for an average duration of 5.2 years (range, 1-17 years). The use of BPs was significantly associated with AFFs (p < 0.001, odds ratio = 25.65; 95% confidence interval = 10.74-61.28). Other independent risk factors for AFFs included osteopenia or osteoporosis, rheumatoid arthritis, increased anterior and lateral femoral curvatures, and thicker lateral femoral cortex at the shaft level. Interaction analyses showed that patients with AFFs using BPs had a significantly higher risk of problematic fracture healing than those with TFFs and no BP treatment.

CONCLUSIONS:

The incidence of AFFs among 6644 hip and femoral fractures was 2.95%. Osteopenia or osteoporosis, use of BPs, rheumatoid arthritis, increased anterior and lateral femoral curvatures, and thicker lateral femoral cortex were independent risk factors for the development of AFFs. Patients with AFFs and BP treatment were more likely to have problematic fracture healing than those with TFFs and no BP treatment.
Keimyung Author(s)(Kor)
민병우
Publisher
School of Medicine (의과대학)
Citation
S.-J. Lim et al. (2018). Incidence, risk factors, and fracture healing of atypical femoral fractures: a multicenter case-control study. Osteoporosis International, 29(11), 2427–2435. doi: 10.1007/s00198-018-4640-4
Type
Article
ISSN
0937-941X
Source
https://link.springer.com/article/10.1007%2Fs00198-018-4640-4
DOI
10.1007/s00198-018-4640-4
URI
https://kumel.medlib.dsmc.or.kr/handle/2015.oak/41300
Appears in Collections:
1. School of Medicine (의과대학) > Dept. of Orthopedic Surgery (정형외과학)
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