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

Lim, Seung‐Jae; Yeo, I; Yoon, Pil Whan; Yoo, Jeong Joon; Rhyu, Kee Hyung; Han, Seung-Beom; Lee, W.-S.; Song, Jae-Ju; Min, Byung-Woo; Park, Y.-S.

doi:10.1007/s00198-018-4640-4

Cited by 39 publications

(25 citation statements)

References 39 publications

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“…These findings are in line with previous results [7]. A shorter treatment duration before the fracture has been suggested to decrease the risk of complicated healing [38,39,42]. However, sample sizes were small in those studies [38].…”

Section: Discussionsupporting

confidence: 91%

“…Nonetheless, these recent reports describe a delayed union when using historic controls or the use of the conventional 6 months as the cut-off point for delayed healing [8,38]. One study found an increased risk of complicated healing in AFF patients compared with controls, even when delayed healing was based not only on radiographic but also clinical signs [39]. Risk estimates in that study, however, were not corrected for differences in patient background characteristics.…”

Section: Discussionmentioning

confidence: 99%

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Increased rate of reoperation in atypical femoral fractures is related to patient characteristics and not fracture type. A nationwide cohort study

et al. 2020

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Atypical femoral fractures are burdened with a high rate of reoperation. In our nationwide analysis, the increased rate of reoperation was related to patient background characteristics, such as age and health status, rather than fracture type. Introduction Patients with atypical fractures are complex to treat and burdened with a high risk of reoperation. We hypothesized that patients with surgically treated, complete atypical fractures have a higher risk of any reoperation and reoperation related to healing complications than patients with common femoral shaft fractures but that this increase would become insignificant when adjusted for predefined characteristics. Methods A cohort of 163 patients with atypical fractures and 862 patients with common femoral shaft or subtrochanteric fractures treated from 2008 to 2010 and who had follow-up radiographs and register data available until 31 December 2014 was included. Reoperations were identified by a complementary review of radiographs and register data and were used to calculate risks for any reoperation and reoperations related to healing complications. Results Patients with atypical fractures were more likely to be reoperated for any reason, age-adjusted OR 1.76 (95% CI, 1.08 to 2.86). However, patients with common fractures had a shorter follow-up due to a threefold higher death rate. Accordingly, in a multivariable-adjusted time-to-event model, the increased risk lost statistical significance for any reoperations, cause-specific HR 1.34 (95% CI, 0.85 to 2.13), and for reoperations related to healing complications, HR 1.32 (95% CI, 0.58 to 3.0). Continued use of bisphosphonate in the first year after the fracture did not affect the reoperation rate. Conclusions Our findings suggest that the increased risk of reoperation after an atypical femur fracture is largely explained by patient characteristics and not fracture type.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Increased rate of reoperation in atypical femoral fractures is related to patient characteristics and not fracture type. A nationwide cohort study

et al. 2020

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“…While antiresorptive drugs usually display a lower incidence of associated side effects, bone turnover suppression can elucidate the necrosis of the jaw and the incidence of atypical femur fractures that can be documented in patients with long-term bisphosphonate usage [27]. Because antiresorptive agents are unable to preserve bone mass and bone integrity, it continues to be of core interest to identify molecular targets that would promote osteoblast activity and lead to enhanced bone mass with reconstructed skeletal architectures.…”

Section: Estrogen Agonist/antagonistmentioning

confidence: 99%

Calcium and Metabolic Bone Disorders

Ale¹,

Akande²,

Rocha-Afodu³

2021

Mineral Deficiencies - Electrolyte Disturbances, Genes, Diet and Disease Interface

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Calcium homeostasis has a pivotal role in regulating many biological processes. The interplay of calcium-regulating hormones, including parathyroid hormone (PTH), vitamin D, and calcitonin, is crucial in tightly maintaining serum calcium levels. Deregulation of calcium homeostasis has clinical implications resulting in hypercalcemia or hypocalcemia, which can lead to metabolic bone disease (MBD). MBD is a group of multifactorial bone diseases, caused by bone demineralization and characterized by an increased susceptibility to fracture risk. This chapter aims to provide an overview of associated risk factors and diagnostic, prevention, and recent treatment methods for MBD. The diagnosis of MBD is based on the assessment of clinical signs, radiological findings, quantitative ultrasonography, and biochemical evaluation of serum calcium, phosphate, PTH, alkaline phosphatase, and vitamin D. Current pharmacological treatments include antiresorptive and anabolic conventional therapies. Additionally, the efficacy of herbal extracts and nutritional supplements have been evaluated. Recent advances in the MBD management include drugs targeting calcium-sensing receptor and parathyroid hormone-related proteins, leading to the development of cathepsin K and Src tyrosine kinase inhibitors, calcilytics, and monoclonal antibodies against sclerostin or Dickkopf-1. Moreover, new nanomaterials have been used for improving the surgical treatment of vertebral fractures.

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“…(8) One of the side-effects that emerged was a SFx in the proximal femoral diaphysis, which progressed to an atypical femoral fracture (AFF). (8)(9)(10)(11)(12)(13) Recently, a case of fracture in the proximal ulna was also reported after prolonged BP treatment. (14) It is now well-accepted that the pathogenesis of AFF is its initiation as a SFx caused by an accumulation of unrepaired microdamage following suppression of bone turnover by BPs.…”

Section: Introductionmentioning

confidence: 99%

“…(22,31,38,42) Patients receiving long-term BP treatment may be at higher risk for development of SFx, and more serious complications including AFF. (8)(9)(10)(11)(12)(13) Although some studies have investigated the effect of combined PTH-BP therapy in osteoporosis, this is not the case for SFx and potential AFF. (43) Therefore, the aim of the current experiment was to investigate the efficacy of a daily iPTH treatment for 14 days in acceleration of SFx remodeling and healing indices in the rat ulna in the presence or absence of a concurrent BP treatment (ALN).…”

Section: Introductionmentioning

confidence: 99%

Intermittent Parathyroid Hormone Accelerates Stress Fracture Healing More Effectively Following Cessation of Bisphosphonate Treatment

et al. 2020

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Parathyroid hormone (PTH) and bisphosphonates (BPs), including alendronate (ALN), have opposing effects on bone dynamics. The extent to which PTH remains effective in the treatment of stress fracture (SFx) in the presence of an ongoing BP treatment has not been tested. SFx was induced in 150 female Wistar rats, divided into five equal groups (n = 30). All rats were pretreated with ALN (1 μg/kg−1/day−1) for 14 days prior to SFx induction, followed by ALN cessation or continuation for the duration of the experiment; this was combined with daily PTH (8 μg/100 g−1/day−1) on SFx induction for 14 days, followed by cessation or continuation of ALN after SFx induction or an equivalent vehicle as a control. Ulnas were examined 2 weeks or 6 weeks following SFx. Two toluidine blue‐ and two tartrate‐resistant acid phosphatase‐stained sections were examined for histomorphometric analysis using Osteomeasure software. There was a significant interaction between the effects of time and treatment type on the woven bone width and apposition rate, as well as an improvement in the woven bone architecture. However, woven bone variables remained unaffected by the cessation or continuation of ALN. Cessation of ALN increased osteoclast number when compared with the ALN‐PTH continuation group (p = 0.006), and vehicle (p = 0.024) after 2 weeks. There was a significant interaction between the effects of time and treatment type on the number of osteoclasts per unit BMU area and length. The number of osteoclasts per unit BMU area and length was significantly greater in ALN cessation groups. It was concluded that intermittent short‐duration iPTH treatment effectively increased remodeling of SFx with a concurrent BP treatment, provided that BP was ceased at the time of SFx. Our results could help develop shorter iPTH treatment protocols for the clinical management of SFxs and guide clinical decision‐making to cease BP treatment in cases of SFx. © 2020 The Authors. JBMR Plus published by Wiley Periodicals LLC. on behalf of American Society for Bone and Mineral Research.

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

Cited by 39 publications

References 39 publications

Increased rate of reoperation in atypical femoral fractures is related to patient characteristics and not fracture type. A nationwide cohort study

Increased rate of reoperation in atypical femoral fractures is related to patient characteristics and not fracture type. A nationwide cohort study

Calcium and Metabolic Bone Disorders

Intermittent Parathyroid Hormone Accelerates Stress Fracture Healing More Effectively Following Cessation of Bisphosphonate Treatment

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