A Retrospective Review of Patients with Atypical Femoral Fractures While on Long-Term Bisphosphonates: Including Pertinent Biochemical and Imaging Studies

Absence of femoral cortical thickening in long-term bisphosphonate users: Implications for atypical femur fractures

“…We identified a low incidence of thigh pain, an absence of radiographic beaking, and no significant increase in cortical thickening in these long term bisphosphonate users. We did observe, as have others [6], that there are a group of patients taking bisphosphonates whose FRAX score (10 year probability of hip fracture) is below the recommended threshold for treatment of osteoporosis.…”

“…As has been previously described, we noted that a number of patients taking bisphosphonates had FRAX hip fracture scores (i.e. 10 year probability of hip fracture) of less than 3% and DEXA scores in the non-osteoporotic range [6]. …”

Atypical Femoral Fractures—Ongoing and History of Bone-Specific Therapy, Concomitant Diseases, Medications, and Survival

“…The median age of our male population (regardless of the type of fracture) was about 1 decade lower than that of the female population and is partly in line with previously published data (39). Male patients in the AFF group were less likely to be currently taking BST, but their history of any previous BST was similar compared to the female population.…”

Are Race and Sex Associated With the Occurrence of Atypical Femoral Fractures?

“…A previous study evaluating patients with atypical femoral fractures from the Kaiser Permanente Northern California cohort found that the largest group was Asians at 49.3% [9]. Another study showed that although the majority of patients were white (72%), a significant percentage of Asian patients (24%) sustained this fracture [15]. Although the percentages of Asians identified were drastically different, each author has argued that their findings were likely attributable to the significant Asian populations at their institutions [9,15].…”

“…There are some reports on the racial and ethnic characteristics of the bisphosphonate user who is at risk for atypical fractures. Some studies have reported high percentages of Asians in their patient populations with atypical femoral fractures [9,14,15]. Similarly, because it is predominantly women who are diagnosed with osteopenia or osteoporosis and who are treated with bisphosphonates, fewer reports have included sex differences [11,22].…”