Skip to main content
SpringerLink
Log in

Factors associated with atypical femoral fracture

  • Original Article - Epidemiology of RMD
  • Published:
Rheumatology International Aims and scope Submit manuscript

Abstract

We aimed to investigate the proportion of atypical femoral fractures (AFF) among Korean femoral fracture patients and examined the factors associated with the development of AFF. Between 2003 and 2013, 607 female patients with low-energy femoral fractures who were hospitalized at a single university hospital were retrospectively enrolled in this study. Patients were classified into two groups according to the fracture site: Patients with subtrochanteric or diaphyseal femoral fractures were included in the AFF group, while patients with intertrochanteric or neck fractures were included in the typical femoral fracture (TFF) group. After comparing clinical and radiographic characteristics between groups, we used multivariable logistic regression analysis to explore risk factors for AFF. Thirty patients (4.9 %) with AFF and 577 patients (95.1 %) with TFF were identified. The AFF group was younger than the TFF group (p < 0.01), and more patients with AFF were treated with bisphosphonate (BP) (p < 0.01) or proton-pump inhibitor (p = 0.02). When comparing the radiographic parameters, the AFF group tended to have a higher cortical thickness index (p = 0.02) and lateral-to-medial cortex ratio (p < 0.01). After adjusting for clinical variables, BP use (OR 8.09, CI 3.09–21.19) and younger age (OR 1.06, CI 1.01–1.11) were associated with AFF. The proportion of AFF was 4.9 % among patients with femoral fractures. Younger age and use of BP before fracture increased the risk of development of AFF in Korean patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Goh SK, Yang KY, Koh JS et al (2007) Subtrochanteric insufficiency fractures in patients on alendronate therapy: a caution. J Bone Joint Surg Br 89:349–353

    Article  PubMed  Google Scholar 

  2. Giusti A, Hamdy NA, Papapoulos SE (2010) Atypical fractures of the femur and bisphosphonate therapy: a systematic review of case/case series studies. Bone 47:169–180

    Article  PubMed  CAS  Google Scholar 

  3. Lee YK, Ha YC, Park C, Yoo JJ, Shin CS, Koo KH (2013) Bisphosphonate use and increased incidence of subtrochanteric fracture in South Korea: results from the National Claim Registry. Osteoporos Int 24:707–711

    Article  PubMed  CAS  Google Scholar 

  4. Wang Z, Bhattacharyya T (2011) Trends in incidence of subtrochanteric fragility fractures and bisphosphonate use among the US elderly, 1996–2007. J Bone Miner Res 26:553–560

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  5. Erviti J, Alonso A, Oliva B et al (2013) Oral bisphosphonates are associated with increased risk of subtrochanteric and diaphyseal fractures in elderly women: a nested case-control study. BMJ Open 3:e002091

    PubMed  PubMed Central  Google Scholar 

  6. Gedmintas L, Solomon DH, Kim SC (2013) Bisphosphonates and risk of subtrochanteric, femoral shaft, and atypical femur fracture: a systematic review and meta-analysis. J Bone Miner Res 28:1729–1737

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  7. Drampalos E, Skarpas G, Barbounakis N, Michos I (2014) Atypical femoral fractures bilaterally in a patient receiving denosumab. Acta Orthop 85:3–5

    Article  PubMed  PubMed Central  Google Scholar 

  8. Perreault S, Dragomir A, Desgagne A et al (2005) Trends and determinants of antiresorptive drug use for osteoporosis among elderly women. Pharmacoepidemiol Drug Saf 14:685–695

    Article  PubMed  CAS  Google Scholar 

  9. Bilezikian JP (2009) Efficacy of bisphosphonates in reducing fracture risk in postmenopausal osteoporosis. Am J Med 122:S14–S21

    Article  PubMed  CAS  Google Scholar 

  10. Bone HG, Hosking D, Devogelaer JP et al (2004) Ten years’ experience with alendronate for osteoporosis in postmenopausal women. N Engl J Med 350:1189–1199

    Article  PubMed  CAS  Google Scholar 

  11. Sim Ie W, Ebeling PR (2013) Treatment of osteoporosis in men with bisphosphonates: rationale and latest evidence. Ther Adv Musculoskelet Dis 5:259–267

    Article  PubMed  CAS  Google Scholar 

  12. Miller PD (2011) The kidney and bisphosphonates. Bone 49:77–81

    Article  PubMed  CAS  Google Scholar 

  13. Cremers SC, Pillai G, Papapoulos SE (2005) Pharmacokinetics/pharmacodynamics of bisphosphonates: use for optimisation of intermittent therapy for osteoporosis. Clin Pharmacokinet 44:551–570

    Article  PubMed  CAS  Google Scholar 

  14. Russell RG, Watts NB, Ebetino FH, Rogers MJ (2008) Mechanisms of action of bisphosphonates: similarities and differences and their potential influence on clinical efficacy. Osteoporos Int 19:733–759

    Article  PubMed  CAS  Google Scholar 

  15. Black DM, Schwartz AV, Ensrud KE et al (2006) Effects of continuing or stopping alendronate after 5 years of treatment: the Fracture Intervention Trial Long-term Extension (FLEX): a randomized trial. JAMA 296:2927–2938

    Article  PubMed  CAS  Google Scholar 

  16. Watts NB, Chines A, Olszynski WP et al (2008) Fracture risk remains reduced one year after discontinuation of risedronate. Osteoporos Int 19:365–372

    Article  PubMed  CAS  Google Scholar 

  17. Watts NB, Diab DL (2010) Long-term use of bisphosphonates in osteoporosis. J Clin Endocrinol Metab 95:1555–1565

    Article  PubMed  CAS  Google Scholar 

  18. Cauley JA (2011) Defining ethnic and racial differences in osteoporosis and fragility fractures. Clin Orthop Relat Res 469:1891–1899

    Article  PubMed  PubMed Central  Google Scholar 

  19. Marcano A, Taormina D, Egol KA, Peck V, Tejwani NC (2014) Are race and sex associated with the occurrence of atypical femoral fractures? Clin Orthop Relat Res 472:1020–1027

    Article  PubMed  PubMed Central  Google Scholar 

  20. Lo JC, Huang SY, Lee GA et al (2012) Clinical correlates of atypical femoral fracture. Bone 51:181–184

    Article  PubMed  Google Scholar 

  21. Singh M, Nagrath AR, Maini PS (1970) Changes in trabecular pattern of the upper end of the femur as an index of osteoporosis. J Bone Joint Surg Am 52:457–467

    PubMed  CAS  Google Scholar 

  22. Dorr LD, Faugere MC, Mackel AM, Gruen TA, Bognar B, Malluche HH (1993) Structural and cellular assessment of bone quality of proximal femur. Bone 14:231–242

    Article  PubMed  CAS  Google Scholar 

  23. Shane E, Burr D, Abrahamsen B et al (2014) Atypical subtrochanteric and diaphyseal femoral fractures: second report of a task force of the American Society for Bone and Mineral Research. J Bone Miner Res 29:1–23

    Article  PubMed  Google Scholar 

  24. Saita Y, Ishijima M, Mogami A et al. (2015) The incidence of and risk factors for developing atypical femoral fractures in Japan. J Bone Miner Metab 33(3):311–318

    Article  PubMed  CAS  Google Scholar 

  25. Shane E, Burr D, Ebeling PR et al (2010) Atypical subtrochanteric and diaphyseal femoral fractures: report of a task force of the American Society for Bone and Mineral Research. J Bone Miner Res 25:2267–2294

    Article  PubMed  Google Scholar 

  26. Schilcher J, Michaelsson K, Aspenberg P (2011) Bisphosphonate use and atypical fractures of the femoral shaft. N Engl J Med 364:1728–1737

    Article  PubMed  CAS  Google Scholar 

  27. Franceschetti P, Bondanelli M, Caruso G et al (2013) Risk factors for development of atypical femoral fractures in patients on long-term oral bisphosphonate therapy. Bone 56:426–431

    Article  PubMed  CAS  Google Scholar 

  28. Annuurad E, Shiwaku K, Nogi A et al (2003) The new BMI criteria for asians by the regional office for the western pacific region of WHO are suitable for screening of overweight to prevent metabolic syndrome in elder Japanese workers. J Occup Health 45:335–343

    Article  Google Scholar 

  29. Lenart BA, Neviaser AS, Lyman S et al (2009) Association of low-energy femoral fractures with prolonged bisphosphonate use: a case control study. Osteoporos Int 20:1353–1362

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  30. Chen F, Wang Z, Bhattacharyya T (2014) Absence of femoral cortical thickening in long-term bisphosphonate users: implications for atypical femur fractures. Bone 62:64–66

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  31. Koeppen VA, Schilcher J, Aspenberg P (2012) Atypical fractures do not have a thicker cortex. Osteoporos Int 23:2893–2896

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, South Korea

    Dam Kim, Yoon-Kyoung Sung & Soo-Kyung Cho

  2. Clinical Research Center for Rheumatoid Arthritis (CRCRA), Seoul, South Korea

    Dam Kim, Yoon-Kyoung Sung, Soo-Kyung Cho & Minkyung Han

  3. Department of Orthopedic Surgery, Hanyang University Hospital, Seoul, South Korea

    Yee-Suk Kim

Authors
  1. Dam Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yoon-Kyoung Sung
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Soo-Kyung Cho
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Minkyung Han
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Yee-Suk Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Yee-Suk Kim.

Ethics declarations

Conflict of interest

Dam Kim, Yoon-Kyoung Sung, Soo-Kyung Cho, Minkyung Han, and Yee-Suk Kim declare that they have no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kim, D., Sung, YK., Cho, SK. et al. Factors associated with atypical femoral fracture. Rheumatol Int 36, 65–71 (2016). https://doi.org/10.1007/s00296-015-3323-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00296-015-3323-0

Keywords

Search

Navigation