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Epidemiology of Atypical Subtrochanteric and Femoral Shaft Fractures

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The Duration and Safety of Osteoporosis Treatment

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Abstract

Subtrochanteric or femoral shaft fractures represent a small subset (10–30 %) of all hip/femur fractures. There may be differences in the clinical characteristics between subtrochanteric and femoral shaft fractures. Atypical femoral fractures (AFFs) are located along the femoral diaphysis from just distal to the lesser trochanter to just proximal to the supracondylar flare and must meet certain criteria (four of five major criteria and minor criteria are not required) to be considered atypical. There may be important clinical differences between the AFF that have minor features present as compared to those that only meet the major features of AFF. AFFs are rare, and the absolute risk of these fractures ranges from 3.2 to 50 cases per 100,000 person-years. Risk factors include prodromal pain (70 %), Asian race, and several comorbid conditions and use of medications. AFFs appear to be more frequent among individuals who are being treated with bisphosphonates, and longer duration of use may further increase risk. However, the risk of AFF is reduced by up to 70 % per year after bisphosphonates are stopped. The benefit of bisphosphonates to prevent osteoporosis-related fractures has been estimated to be 100-fold greater than the risk of AFF.

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Notes

  1. 1.

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Authors and Affiliations

  1. Department of Epidemiology and Clinical Research Center, Helen Hayes Hospital and Columbia University, 55 Route 9W, West Haverstraw, NY, 10993, USA

    Jeri W. Nieves PhD

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Correspondence to Jeri W. Nieves PhD .

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Editors and Affiliations

  1. Division of Rheumatology, Department of Medicine, Cedars-Sinai Medical Center; University of California Los Angeles, David Geffen School of Medicine, Los Angeles, California, USA

    Stuart Silverman

  2. Institute of Clinical Research; Department of Medicine, Holbæk, Denmark, University of Southern Denmark, Odense Patient Data Explorative Network; Holbæk Hospital, Odense, Denmark

    Bo Abrahamsen

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Nieves, J.W. (2016). Epidemiology of Atypical Subtrochanteric and Femoral Shaft Fractures. In: Silverman, S., Abrahamsen, B. (eds) The Duration and Safety of Osteoporosis Treatment. Springer, Cham. https://doi.org/10.1007/978-3-319-23639-1_6

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  • DOI: https://doi.org/10.1007/978-3-319-23639-1_6

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