Subtrochanteric/femoral shaft Versus hip fractures: Incidences and identification of risk factors

Abstract

Subtrochanteric and femoral shaft (ST/FS) fractures are now considered to be fragility fractures in osteoporotic patients. Although rare, there is growing evidence of the burden that they constitute. Little is known about the change over time in incidence of ST/FS fractures. We assessed the incidence of ST/FS fractures and the associated risk factors from 2002 to 2009 compared with those of hip fractures. Data were obtained from the French National Database, which includes all hospital discharge codes from acute care facilities. Hospitalizations for primary surgical management of neck/trochanteric (hip) and ST/FS fractures in patients aged above 50 years were selected and described for different age groups. Incidences per million populations were calculated using the estimated French population adjusted for each year, age, and gender. We studied the change for each fracture site. The comorbidity factors related to these fractures were assessed in 2009 using multivariate logistic regression. From 2002 to 2009, the adjusted incidence of hip fractures decreased continuously from 4368 to 3662 in women ( p < 0.0001), and a mild increase from 1476 to 1384 in men ( p < 0.0001) after an initial decrease. In contrast, the incidence of ST/FS increased significantly in both genders (from 353 to 395 in women, from 146 to 159 in men).

Real frequency of ordinary and atypical sub-trochanteric and diaphyseal fractures in France based on X-rays and medical file analysis

“…This ratio dropped down to 7.35%, when determined by radiological analysis and after excluding pathological, traumatic and per prosthetic fractures, fragility ST/FS fractures only represented 2.25% of all femoral fractures in our study. This result is much lower than previously reported [1,3,9,10,17,21], suggesting a potential bias in the interpretation of the study results only based on registered data related to a high rate of miscoding specific to this fracture location. Misclassification has been previously reported in literature.…”

Atypical Subtrochanteric and Diaphyseal Femoral Fractures: Second Report of a Task Force of the American Society for Bone and Mineral Research

“…Over the 5‐year study period, the number of prescriptions of BP increased significantly. In summary, most studies, although not all, have found the incidence of ST/FS fractures has increased and that the age‐adjusted rate of these fractures in women is between 10 and 35 per 100,000.…”

“…This rise in incidence mainly occurred in women over age 60 years and was accounted for by minimal to moderate trauma fractures. An analysis of the French National Database found that age‐adjusted FN/IT fracture incidence in women decreased significantly between 2002 and 2009, but incidence of ST/FS increased significantly . Lee and colleagues used national claims data to identify hip and femur fractures in South Korea, based on ICD‐10 codes.…”

Predicting Need for Fixation of Atypical Femoral Fracture

“…Atypical femoral fractures have been an increasing concern in the treatment of osteoporosis, especially with bisphospho- nates (13)(14)(15)(16)(17). Our objectives were to evaluate the clinical results with incomplete atypical femoral fractures and to determine factors associated with the requirement for fixation in these conditions.…”