Critical differences between subtrochanteric and diaphyseal atypical femoral fractures: analyses of 51 cases at a single institution in Korean population

Cho, Yoon-Je; Kang, Kyung-Chung; Yuan, Chun Su; Rhyu, Kee Hyung; Kim, Sang-Jun; Jang, Taesu

doi:10.1007/s11657-018-0457-1

Cited by 11 publications

(8 citation statements)

References 19 publications

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“…The differences between diaphyseal and subtrochanteric AFFs have been examined in several studies. It has been reported that compared to subtrochanteric AFFs, [15][16][17][18][19][20]. Oh et al [17] examined the mechanical load on femurs with and without the femoral curvature.…”

Section: Discussionmentioning

confidence: 99%

“…It has been reported that compared to subtrochanteric AFFs, [15][16][17][18][19][20]. Oh et al [17] examined the mechanical load on femurs with and without the femoral curvature. They found that when the femoral curvature is large, the load is mostly applied to the outside of the femoral shaft, whereas when the curvature is small, the load is applied within the vicinity of the femoral trochanter; their study showed that the degree of curvature greatly influenced the site of AFF [17].…”

Section: Discussionmentioning

confidence: 99%

“…Oh et al [17] examined the mechanical load on femurs with and without the femoral curvature. They found that when the femoral curvature is large, the load is mostly applied to the outside of the femoral shaft, whereas when the curvature is small, the load is applied within the vicinity of the femoral trochanter; their study showed that the degree of curvature greatly influenced the site of AFF [17]. In our study, the ROC of the femur was found to be small in diaphyseal AFFs, and these AFFs were determined to have been greatly influenced by the femoral curvature.…”

Section: Discussionmentioning

confidence: 99%

“…However, in recent years, the differences between subtrochanteric and diaphyseal AFFs have been examined. Differences in the backgrounds of patients with each type of AFF have been reported, and the corresponding differences underlying the AFF development mechanisms in these patients have been proposed [15][16][17][18][19][20].…”

Section: Introductionmentioning

confidence: 99%

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Evaluation of the Nature and Etiologies of Risk Factors for Diaphyseal Atypical Femoral Fractures

et al. 2021

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Objectives: Differences in the mechanisms of subtrochanteric and diaphyseal atypical femoral fractures (AFFs) have been speculated in studies that have analyzed differences in the patients’ backgrounds. However, the etiologies of each type of AFF have not been investigated in detail. Therefore, this study aimed to investigate the nature and etiologies of the risk factors for diaphyseal AFFs. Materials and Methods: Eighty consecutive Japanese patients with 91 diaphyseal AFFs (the AFF group) and 110 age-matched female patients with osteoporosis (the non-AFF control group) were included. Their clinical data were compared and the factors affecting AFFs were investigated. Furthermore, the etiologies of the risk factors for diaphyseal AFFs were examined. Results: Multivariate analysis revealed that femoral serrated changes, bisphosphonate or denosumab usage, and lateral and anterior femoral curvatures were the risk factors for diaphyseal AFFs (p<0.0011, p=0.0137, and p<0.0001, respectively). Multivariate analyses also revealed that serrated changes and low serum 25(OH)D levels affected the lateral curvature (p=0.0088 and 0.0205, respectively), while serrated changes affected the anterior curvature (p=0.0006); each significantly affected the femoral curvature. In addition, a high serum calcium (Ca) level, lateral femoral curvature, and anterior femoral curvature were the predictors of serrated changes (p=0.0146, 0.0002, and 0.0098, respectively). Conclusion: The risk factors for diaphyseal AFFs were bone resorption inhibitor usage, a strong femoral curvature, and serrated changes. A low serum 25(OH)D level and serrated changes are the risk factors for lateral curvature, while a high serum Ca level is a risk factor for serrated changes.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Evaluation of the Nature and Etiologies of Risk Factors for Diaphyseal Atypical Femoral Fractures

et al. 2021

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“…Specifically, the femoral neck shaft bowing angle affect the subtrochanteric versus diaphyseal location of the AFF. 33,34 A bowed femur, which is more common in patients of Asian descent, may increase the risk of AFF because the bending induces substantial levels of tensile stress on the lateral cortex of the femur. 35,36 Surprisingly, some cohort studies in South Korea have found nearly 25% of patients with AFF have not had a history of BMA use, 31 thus suggesting inherent AFF risk.…”

Section: Risk Factorsmentioning

confidence: 99%

The limitations of today’s clinical guidance: Atypical femoral fracture and long-term bone-modifying agents in the oncology setting

Cheung

Borno

2020

J Oncol Pharm Pract

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While bone-modifying agents such as bisphosphonates and denosumab are crucial to preventing skeletal-related events in patients with bone metastases, the optimal duration remains undefined. Extended duration may be associated with adverse effects such as osteonecrosis of the jaw and atypical femoral fracture. Although uncommon, atypical femoral fracture represents a serious consequence of prolonged bone-modifying agent use and are characterized by a prodrome and distinct radiographic findings. The oncology setting encompasses a unique set of atypical femoral fracture risk factors and considerations, with hormonal therapy in early stage disease, bone metastases in the advanced setting, and new targeted agents that may affect bone homeostasis. As outcomes in cancer treatment continue to improve, the questions of risks versus benefits of long-term bone-modifying agents and how to mitigate atypical femoral fracture risk become increasingly pertinent.

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High doses of zoledronic acid induce differential effects on femur and jawbone microstructure

Soares

Dessel

Jacobs

et al. 2022

Clinical & Exp Dental Res

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Objectives: The aim of this study is to investigate the long-term effects on jaw and femur bone induced by oncologic doses of zoledronic acid in a young rat model.Material and Methods: Six 12-week-old male Wistar rats received zoledronic acid (0.6 mg/kg) and six control rats received saline solution in the same volume.Compounds were administered intraperitoneally in five doses every 28 days.Euthanasia was performed 150 days after therapy onset. After animal sacrifice, their mandibles and femurs were scanned ex vivo using a high-resolution (14 μm) micro-computed tomography. Morphometric bone parameters were calculated using CT-Analyzer (Bruker, Belgium) between the first and second mandibular molars and in the distal femur metaphysis and epiphysis. Results:The treatment group as compared to the controls showed a significantly (p < .05) increased bone quantity (↑BV/TV, ↓Po[Tot], ↑Tb.Th), bone density (↑TMD, ↑BMD), and osteosclerosis of the trabecular bone (↓Tb.Sp, ↓Conn.Dn, ↓Tb.Pf, ↓SMI) in all anatomical sites. Bone remodeling suppression due to zoledronic acid treatment was more pronounced (p < .05) in the femoral metaphysis relative to the mandible and epiphysis. The exploratory linear discriminant analysis showed that for the mandible, it was mainly the bone quantity-related morphometric indices (BV/TV and Tb.Th), while for the femoral epiphysis and metaphysis, it was bone structure-related (Tb.Pf and Tb.N), which are of primary importance to study the treatment effect. Conclusion:High doses of bisphosphonates can differently affect the bone quantity, density, and structure in long bones and jawbones. In the metaphysis, bone changes were primarily concentrated in the region of the growth plate. Future studies may consider the use of bone morphometric indices to evaluate the effect of bisphosphonates.

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Critical differences between subtrochanteric and diaphyseal atypical femoral fractures: analyses of 51 cases at a single institution in Korean population

Abstract: Angle of lateral bowing (FNSBA) and spine BMD showed significant differences between subtrochanteric and diaphyseal atypical fracture groups. According to our results, femoral bowing and spine BMD may play important roles in the AFF locations.

Cited by 11 publications

References 19 publications

Evaluation of the Nature and Etiologies of Risk Factors for Diaphyseal Atypical Femoral Fractures

Evaluation of the Nature and Etiologies of Risk Factors for Diaphyseal Atypical Femoral Fractures

The limitations of today’s clinical guidance: Atypical femoral fracture and long-term bone-modifying agents in the oncology setting

High doses of zoledronic acid induce differential effects on femur and jawbone microstructure

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