The fracture sites of atypical femoral fractures are associated with the weight-bearing lower limb alignment

Saita, Yoshitomo; Ishijima, Muneaki; Mogami, Atsuhiko; Kubota, Mitsuaki; Baba, Tomonori; Kaketa, Takefumi; Nagao, Masashi; Sakamoto, Yuko; Sakai, Kensuke; Kato, Rui; Nagura, Nana; Miyagawa, Kei; Wada, Tomoki; Liu, Lizu; Obayashi, Osamu; Shitoto, Katsuo; Nozawa, Masahiko; Kajihara, Hajime; Gen, Hogaku

doi:10.1016/j.bone.2014.06.008

Cited by 70 publications

(36 citation statements)

References 35 publications

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“…First, Asians are known to have unique femur geometry compared to women of white race. Both in the U.S. [15] and Asia [16], femur geometry has been suggested as a factor in the risk of both femur stress fractures and completed AFFs. These geometric factors may include smaller bone size, shorter hip axis length, larger femur varus angle and bowing, all contributing to increased tensile stresses on the lateral femur [7, 15–19].…”

Section: Discussionmentioning

confidence: 99%

“…These geometric factors may include smaller bone size, shorter hip axis length, larger femur varus angle and bowing, all contributing to increased tensile stresses on the lateral femur [7, 15–19]. Biomechanical forces affecting both femurs might further explain the predisposition for bilateral symmetric femur pathology in reported cases [10, 16, 18]. Future studies should examine the role of osteometry and potentially relevant nutritional factors (e.g.…”

Section: Discussionmentioning

confidence: 99%

“…As such, they may have been more active, with femurs susceptible to greater every day mechanical forces. In the face of potentially impaired bone remodeling resulting from BP therapy, these activities could contribute to the initial stress lesions in the lateral femoral cortex that ultimately progress to complete fracture [6, 16, 21]. Although we adjusted for age, we did not have systematic information pertaining to physical activity, body size or stature, and bone mineral density (BMD) for this BP initiation cohort.…”

Section: Discussionmentioning

confidence: 99%

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The association of race/ethnicity and risk of atypical femur fracture among older women receiving oral bisphosphonate therapy

Hui

Grimsrud

et al. 2016

Bone

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Purpose Several epidemiologic studies suggest that compared to white women, Asians have a greater propensity to suffer an atypical femur fracture (AFF) while taking bisphosphonate therapy. This study examines the relative risk of AFF following bisphosphonate initiation for Asian compared to white women. Methods Using data from a large integrated northern California healthcare delivery system, we examined diaphyseal femur fracture outcomes among women age ≥50 years old who initiated oral bisphosphonate therapy during 2002–2007. An AFF was defined by the 2013 American Society of Bone and Mineral Research Task Force criteria. The risk of radiographically-confirmed AFF was examined for Asian compared to white women, adjusting for differences in bisphosphonate exposure and other potential risk factors. Results Among 48,390 women (65.3% white, 17.1% Asian) who newly initiated bisphosphonate therapy and were followed for a median of 7.7 years, 68 women experienced an AFF. The rate of AFF was 18.7 per 100,000 person-years overall and eight-fold higher among Asian compared to white women (64.2 versus 7.6 per 100,000 person-years). Asians were also more likely to have longer bisphosphonate treatment duration compared to whites (median 3.8 versus 2.7 years). The age-adjusted relative hazard for AFF was 8.5 (95% confidence interval 4.9–14.9) comparing Asian to white women, and was only modestly reduced to 6.6 (3.7–11.5) after adjusting for bisphosphonate duration and current use. Conclusions Our study confirms marked racial disparity in AFF risk that should be further investigated, particularly the mechanisms accounting for this difference. These findings also underscore the need to further examine the association of bisphosphonate duration and AFF in women of Asian race, as well as differential risk across Asian subgroups. In the interim, counseling of Asian women about osteoporosis drug continuation should include consideration of their potentially higher AFF risk.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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The association of race/ethnicity and risk of atypical femur fracture among older women receiving oral bisphosphonate therapy

Hui

Grimsrud

et al. 2016

Bone

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“…Comorbidities and functional status [23] of the study population are also investigated. From our fracture database, characteristics of fracture and surgery that include injury mechanism, fracture location, fracture height [8], bilaterality, operation time, and the time interval from injury to operation were identified. Fracture location was categorized into two groups (subtrochanteric and diaphyseal).…”

Section: Methodsmentioning

confidence: 99%

Atypical Complete Femoral Fractures Associated with Bisphosphonate Use or Not Associated with Bisphosphonate Use: Is There a Difference?

Kim

Park

Moon

et al. 2016

BioMed Research International

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The purpose of this study is to compare clinical characteristics and surgical outcome of atypical complete femoral fractures associated with bisphosphonates (BPs) use and those of fractures not associated with BPs use. Seventy-six consecutive patients (81 fractures) who had been operatively treated for a complete atypical femoral fracture were recruited. Of the 81 fractures, 73 occurred after BPs medication of at least 3 years (BP group) while 8 occurred without a history of BP medication (non-BP group). There were no differences in demographic data and fracture- and surgery-associated factors between the two groups. Of 76 patients (81 fractures), 54 (66.7%) fractures showed bony union within 6 months after the index surgery and 23 (28.4%) showed delayed union at a mean of 11.2 months (range, 8–18 months). The remaining 4 fractures were not healed, even 18 months after the index surgery. There was no difference in healing rate between the BP group and the non-BP group. There were strong correlations between the fracture height and the degree of bowing regardless of BPs medication. All fractures except 1 occurred at the diaphyseal region of the femur when not associated with BP medication.

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“…However, once it occurs, it takes much time to heal [64,65], and the daily life activities of the patient are often impaired. Risk factors for AFF other than long-term BP use include glucocorticoid therapy [66,67], complicating connective tissue disease [67], lateral bowing of the femur [68,69], a low level of serum 25-hydroxyvitamin D [66], and female gender [70]. Glucocorticoid therapy has been reported to have an important impact on AFF [66,67], although no signiicant…”

Section: Atypical Femoral Fracturementioning

confidence: 99%

Idiopathic Osteonecrosis and Atypical Femoral Fracture in Systemic Lupus Erythematosus

Kuroda¹,

Sato²

2017

Lupus

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Osteonecrosis and osteoporosis are frequent adverse efects of glucocorticoid therapy of systemic lupus erythematosus (SLE). Idiopathic osteonecrosis (ION) of the femoral head occurs in 3-40% of patients receiving glucocorticoid, and can also develop in other bones. Higher doses of glucocorticoid and steroid pulse therapy are considered to be risk factors for ION of the femoral head. To analyze these risk factors, it seems important to detect early changes in the femoral head by magnetic resonance imaging and to monitor early clinical events atributable to steroid therapy. Prophylaxis with statins and warfarin remains debatable. The use of glucocorticoid is increase the risk of bone fractures. Bisphosphonate (BP) is used for its prevention and treatment of osteoporosis. Atypical femoral fracture (AFF) has been recently recognized as a complication associated with BP use. AFF is considered to be a form of stress fracture; localized periosteal thickening of the lateral cortex is often present at the fracture site. The thickening has been recently recognized as a complication associated with the use of antiresorptive agents such as BP and denosumab. As long-term BP/glucocorticoid use is a risk factor for beaking in patients with SLE , temporary withdrawal of BP administration should be considered.

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The fracture sites of atypical femoral fractures are associated with the weight-bearing lower limb alignment

Cited by 70 publications

References 35 publications

The association of race/ethnicity and risk of atypical femur fracture among older women receiving oral bisphosphonate therapy

The association of race/ethnicity and risk of atypical femur fracture among older women receiving oral bisphosphonate therapy

Atypical Complete Femoral Fractures Associated with Bisphosphonate Use or Not Associated with Bisphosphonate Use: Is There a Difference?

Idiopathic Osteonecrosis and Atypical Femoral Fracture in Systemic Lupus Erythematosus

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